Healthcare Provider Details

I. General information

NPI: 1154332484
Provider Name (Legal Business Name): JILL LYNNETTE NESHAM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL LYNNETTE BELSKI AU.D.

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CENTER ST NE STE 102
CEDAR RAPIDS IA
52402-5500
US

IV. Provider business mailing address

1500 CENTER ST NE STE 102
CEDAR RAPIDS IA
52402-5500
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-4673
  • Fax: 319-200-4068
Mailing address:
  • Phone: 319-393-4673
  • Fax: 319-200-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-001177
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number814
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00533
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier1448704
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: