Healthcare Provider Details

I. General information

NPI: 1336127877
Provider Name (Legal Business Name): JANA L MARLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANA L SERBOUSEK MD

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 C AVE NE
CEDAR RAPIDS IA
52402-1349
US

IV. Provider business mailing address

6911 C AVE NE
CEDAR RAPIDS IA
52402-1349
US

V. Phone/Fax

Practice location:
  • Phone: 319-832-1463
  • Fax: 319-832-1469
Mailing address:
  • Phone: 319-832-1463
  • Fax: 319-832-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30671
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4111591
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier080149543
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerRR MEDICARE
# 3
Identifier1336127877
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 4
Identifier3111591
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 5
Identifier6111591
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 6
Identifier7111591
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 7
Identifier5111591
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: