Provider Demographics
NPI: | 1750360228 |
---|---|
Name: | SIELEMAN, JANE DONNETTE (PNP) |
Entity type: | Individual |
Prefix: | |
First Name: | JANE |
Middle Name: | DONNETTE |
Last Name: | SIELEMAN |
Suffix: | |
Gender: | F |
Credentials: | PNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 905 FRANKLIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | WATERLOO |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50703-4407 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-272-4300 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 905 FRANKLIN ST |
Practice Address - Street 2: | |
Practice Address - City: | WATERLOO |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50703-4407 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-272-4300 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-12 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | C-050348 | 363LP0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 0076372 | Medicaid | |
IA | C050348 | Other | IOWA STATE LICENSE # |
IA | 15689 | Other | WELLMARK BCBS |
IA | 5200529 | Other | IOWA CONTROLLED SUBSTANCE |
IA | 5200529 | Other | IOWA CONTROLLED SUBSTANCE |