Healthcare Provider Details

I. General information

NPI: 1396379095
Provider Name (Legal Business Name): JENNIFER ANN VANDER ZEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 10TH ST SE
CEDAR RAPIDS IA
52403-2442
US

IV. Provider business mailing address

411 10TH ST SE
CEDAR RAPIDS IA
52403-2442
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-1549
  • Fax: 319-366-1540
Mailing address:
  • Phone: 319-366-1549
  • Fax: 319-366-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number077885
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: