Healthcare Provider Details

I. General information

NPI: 1376539239
Provider Name (Legal Business Name): JOLENE FAYE MEIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 6TH AVE NE
LE MARS IA
51031-3716
US

IV. Provider business mailing address

1000 9TH AVE SE
LE MARS IA
51031-3816
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-3645
  • Fax: 712-546-3644
Mailing address:
  • Phone: 712-546-3645
  • Fax: 712-546-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28700
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: