MEDICARE: JACLYN MARIE DOHLMAN ARNP

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
1	363LF0000X	Family Nurse Practitioner	A143536	IA

General Provider Information

NPI Number	:	1528533056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN MARIE DOHLMAN ARNP

Provider Business Mailing Address
First Line	:	54 FOUR WINDS DR
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-1102
Country	:	US
Telephone Number	:	507-990-4766
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S 17TH ST
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-2304
Country	:	US
Telephone Number	:	641-357-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	08/13/2024

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