1356540884 NPI number — DR. JEAN DORTHY HERMSEN DO

Table of content: SAMANTHA AISHA SUSAG (NPI 1285209577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356540884 NPI number — DR. JEAN DORTHY HERMSEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMSEN
Provider First Name:
JEAN
Provider Middle Name:
DORTHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356540884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 DUFF AVENUE
Provider Second Line Business Mailing Address:
MCFARLAND CLINIC PC
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-239-4480
Provider Business Mailing Address Fax Number:
515-239-4716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 DUFF AVENUE
Provider Second Line Business Practice Location Address:
MCFARLAND CLINIC PC
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-239-4480
Provider Business Practice Location Address Fax Number:
515-239-4716
Provider Enumeration Date:
07/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  4309 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0905X , with the licence number: 5101017240 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 04309 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)