KRISTINE M STAHELI JACKSON NPI 1205847845

NPI Information

NPI: 1205847845
Provider Name: KRISTINE M STAHELI JACKSON
Classification: Non-Pharmacy Dispensing Site - 332900000X
Entity Type: Organization
Address:
HILLCREST FAMILY SERVICES CLINIC
220 W 7TH ST
DUBUQUE, IA
ZIP 52001
Phone: (563) 583-6431
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KRISTINE M STAHELI JACKSON is a non pharmacy dispensing site in Dubuque, IA. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) KRISTINE M STAHELI JACKSON NPI is 1205847845. The provider is registered as an organization entity type.

The provider's business location address is:

HILLCREST FAMILY SERVICES CLINIC
220 W 7TH ST
DUBUQUE, IA
ZIP 52001
Phone: (563) 583-6431
Fax: (563) 557-4447

The provider's authorized official is Gary Gansemer .
The authorized official title is Ceo and has the following contact phone number (563) 583-7357.

The enumeration date for this NPI number is 8/10/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332900000X	Non-Pharmacy Dispensing Site		F066142	IOWA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0140087	MEDICAID	IOWA
2	1621653	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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