Provider Demographics
NPI:1306873948
Name:VAN DYKE, DEBORAH J (ARNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-833-5830
Mailing Address - Fax:319-833-5831
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-833-5830
Practice Address - Fax:319-833-5831
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA103984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29174OtherWELLMARK HEALTH CARE
IA421417307M7OtherJOHN DEERE HEALTH
IA1421941Medicaid
IAI18757Medicare PIN
IA29174OtherWELLMARK HEALTH CARE