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General NPI Number Information
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NPI Number | 1972867273
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Entity Type | Individual
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Provider Name | KATHY JEAN DUSTHIMER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 465 AVENUE OF THE CITIES SUITE 140
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City | EAST MOLINE
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State | IL
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Zip | 61244-4044
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Country | US
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Telephone | 309-755-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 3722 FOREST RD
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City | DAVENPORT
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State | IA
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Zip | 52807-2347
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Country | US
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Telephone | 563-355-5418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209008075
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License Number State | IL
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