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NPI Code Detail

MEDICARE: HEIDI M BONTHUIS PA--C

MEDICARE: HEIDI M BONTHUIS PA--C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant000826IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3IA0133OTHERJOHN DEERE HEALTH CARE

General Provider Information

NPI Number : 1164421954
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI M BONTHUIS PA--C
Provider Business Mailing Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-874-3000
Fax Number : 319-874-3411
Provider Business Practice Location Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-272-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 04/30/2018

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Directions to “ HEIDI M BONTHUIS PA--C” Practice Location

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