Provider Demographics
NPI:1336577790
Name:DETMERING, JUDITH (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DETMERING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2018
Mailing Address - Country:US
Mailing Address - Phone:641-494-9241
Mailing Address - Fax:
Practice Address - Street 1:706 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2018
Practice Address - Country:US
Practice Address - Phone:641-494-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121294163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse