Healthcare Provider Details

I. General information

NPI: 1356540884
Provider Name (Legal Business Name): JEAN DORTHY HERMSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVENUE MCFARLAND CLINIC PC
AMES IA
50010-3014
US

IV. Provider business mailing address

1215 DUFF AVENUE MCFARLAND CLINIC PC
AMES IA
50010-3014
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4480
  • Fax: 515-239-4716
Mailing address:
  • Phone: 515-239-4480
  • Fax: 515-239-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04309
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number4309
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101017240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: