Provider Demographics
NPI:1801126792
Name:RAASCH, JESSICA O (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:O
Last Name:RAASCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-344-9292
Mailing Address - Fax:563-344-9573
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-344-9292
Practice Address - Fax:563-344-9573
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA213140006OtherMEDICARE INDIVIDUAL PTAN
ILIL2709013OtherINDIVIDUAL PTAN