=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124814280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JWDR DIALYSIS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 DELHI ST STE 2100
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-589-4033
-----------------------------------------------------
Fax | 563-556-1028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 DELHI ST STE 2100
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-589-4033
-----------------------------------------------------
Fax | 563-556-1028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN E WHALEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 563-590-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------