Provider Demographics
NPI:1700887866
Name:JEFFREY, DIANA M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:M
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5036
Mailing Address - Country:US
Mailing Address - Phone:319-368-5970
Mailing Address - Fax:319-368-5973
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-368-5970
Practice Address - Fax:319-368-5973
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA093550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA571220779OtherWELLMARK BCBS
IAP00466179OtherRAILROAD MEDICARE
IA1433284Medicaid
IA1433284Medicaid
IAQ09207Medicare UPIN