Provider Demographics
NPI:1932581881
Name:DEUTMEYER, MARY ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:DEUTMEYER
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 1:945 TOWER PARK DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9098
Mailing Address - Country:US
Mailing Address - Phone:319-235-1230
Mailing Address - Fax:319-235-1229
Practice Address - Street 1:945 TOWER PARK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9098
Practice Address - Country:US
Practice Address - Phone:319-235-1230
Practice Address - Fax:319-235-1229
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA096094364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health