Healthcare Provider Details

I. General information

NPI: 1386338085
Provider Name (Legal Business Name): JACLYN MARIE HOUSEAL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 07/10/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 WESTMARK DR
DUBUQUE IA
52002-2626
US

IV. Provider business mailing address

26938 CENTERVILLE RD
LA MOTTE IA
52054-9563
US

V. Phone/Fax

Practice location:
  • Phone: 563-583-9300
  • Fax: 563-557-5574
Mailing address:
  • Phone: 563-513-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA174674
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number150024
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: