Provider Demographics
NPI:1740269976
Name:NIELSENDEJONG, DEBORAH R (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:R
Last Name:NIELSENDEJONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4246
Mailing Address - Country:US
Mailing Address - Phone:641-672-3100
Mailing Address - Fax:641-672-3111
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4246
Practice Address - Country:US
Practice Address - Phone:641-672-3100
Practice Address - Fax:641-672-3111
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28765207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6110353Medicaid
IA09642OtherIA BLUE SHIELD PROVIDER N
IAP00114109OtherRR MEDICARE PROVIDER NUMB
IAF35146Medicare UPIN
IAI11577Medicare Oscar/Certification