Healthcare Provider Details

I. General information

NPI: 1497714646
Provider Name (Legal Business Name): REBECCA S JIMENEZ C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT STREET SUITE 400
DES MOINES IA
50309-1418
US

IV. Provider business mailing address

1215 PLEASANT STREET SUITE 400
DES MOINES IA
50309-1418
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-5722
  • Fax: 515-241-4403
Mailing address:
  • Phone: 515-241-5722
  • Fax: 515-241-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD064621
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number123902
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: