Healthcare Provider Details

I. General information

NPI: 1992480214
Provider Name (Legal Business Name): ALLYSON JANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 UTICA RIDGE RD
BETTENDORF IA
52722-1626
US

IV. Provider business mailing address

634 N CODY RD
LE CLAIRE IA
52753-9673
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-5000
  • Fax:
Mailing address:
  • Phone: 608-732-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number133097
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: