Provider Demographics
NPI:1811252448
Name:HIXENBAUGH, ROSEANNE (ARNP)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:HIXENBAUGH
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 1:924 52ND CT
Mailing Address - Street 2:
Mailing Address - City:WDM
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2715
Mailing Address - Country:US
Mailing Address - Phone:515-225-7765
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5807
Practice Address - Fax:515-699-5779
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA363L00000XOtherVA