Healthcare Provider Details

I. General information

NPI: 1790256048
Provider Name (Legal Business Name): JENNY LYNN BOTSFORD ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH ST SE
CEDAR RAPIDS IA
52403-2414
US

IV. Provider business mailing address

7535 NORMANDY DR NE
CEDAR RAPIDS IA
52402-6917
US

V. Phone/Fax

Practice location:
  • Phone: 319-399-2022
  • Fax:
Mailing address:
  • Phone: 319-360-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA129497
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: