Provider Demographics
NPI:1700990066
Name:DINGEMAN, JILL (PA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DINGEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-0690
Mailing Address - Fax:515-643-0936
Practice Address - Street 1:95 UNIVERSITY AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3120
Practice Address - Country:US
Practice Address - Phone:515-237-3985
Practice Address - Fax:515-237-3994
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI6726Medicare ID - Type Unspecified
IAQ60664Medicare UPIN