Basic Information
| Provider Information | |||||||||
| NPI: | 1154761021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN MEETEREN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3755 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023542100 | ||||||||
| FaxNumber: | 4023542155 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 EBAUGH ST | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515341811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125275204 | ||||||||
| FaxNumber: | 7125279346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A142336 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 111506 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 68917 | NE | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 47068731734 | 05 | NE | MEDICAID | 47068731749 | 05 | NE | MEDICAID | 1154761021 | 05 | IA | MEDICAID | 10026480100 | 05 | NE | MEDICAID | 47068731712 | 05 | NE | MEDICAID | 47068731777 | 05 | NE | MEDICAID | 47068731741 | 05 | NE | MEDICAID |