Provider Demographics
NPI:1881224376
Name:BRANDMEYER, JACLYN ALICE HEISER
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ALICE HEISER
Last Name:BRANDMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DEXTER CT STE 104
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3419
Mailing Address - Country:US
Mailing Address - Phone:563-214-1594
Mailing Address - Fax:
Practice Address - Street 1:3400 DEXTER CT STE 104
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3419
Practice Address - Country:US
Practice Address - Phone:563-214-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157616363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner