Basic Information
Provider Information | |||||||||
NPI: | 1578216263 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | UHLMANN | ||||||||
FirstName: | JESSICA | ||||||||
MiddleName: | RAE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HRUBY | ||||||||
OtherFirstName: | JESSICA | ||||||||
OtherMiddleName: | RAE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2431 WILEY BLVD SW # 1013 | ||||||||
Address2: |   | ||||||||
City: | CEDAR RAPIDS | ||||||||
State: | IA | ||||||||
PostalCode: | 524046003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196664224 | ||||||||
FaxNumber: | 8773843106 | ||||||||
Practice Location | |||||||||
Address1: | 1500 1ST AVE | ||||||||
Address2: |   | ||||||||
City: | CORALVILLE | ||||||||
State: | IA | ||||||||
PostalCode: | 522411192 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196664224 | ||||||||
FaxNumber: | 8773843106 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2022 | ||||||||
LastUpdateDate: | 07/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/19/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A165857 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.