Basic Information
Provider Information | |||||||||
NPI: | 1861756918 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHEFFIELD | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | KRISTINE | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KRUPICKA | ||||||||
OtherFirstName: | JENNIFER | ||||||||
OtherMiddleName: | KRISTINE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 405 MONROE ST | ||||||||
Address2: |   | ||||||||
City: | PELLA | ||||||||
State: | IA | ||||||||
PostalCode: | 502191189 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6416283832 | ||||||||
FaxNumber: | 6416212335 | ||||||||
Practice Location | |||||||||
Address1: | 405 MONROE ST | ||||||||
Address2: |   | ||||||||
City: | PELLA | ||||||||
State: | IA | ||||||||
PostalCode: | 502191189 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6416283832 | ||||||||
FaxNumber: | 6416212335 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2012 | ||||||||
LastUpdateDate: | 09/30/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 002307 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | P01094894 | 01 | IA | RR MEDICARE | OTHER | 1861756918 | 01 | ID | NPI | OTHER | 002307 | 01 | ID | IOWA LICENSE | OTHER |