MEDICARE: DEBBIE ANN DETTMER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	P21144	IA

General Provider Information

NPI Number	:	1134630791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE ANN DETTMER LPN

Provider Business Mailing Address
First Line	:	3830 43RD ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-3629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 PARKRIDGE AVE
Second Line	:
City	:	PLEASANT HILL
State	:	IA
Zip	:	50327-7228
Country	:	US
Telephone Number	:	515-265-5348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	10/23/2017

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Directions to “ DEBBIE ANN DETTMER LPN” Practice Location

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