Provider Demographics
NPI:1336127877
Name:MARLETT, JANA L (MD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:L
Last Name:MARLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:L
Other - Last Name:SERBOUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6911 C AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1349
Mailing Address - Country:US
Mailing Address - Phone:319-832-1463
Mailing Address - Fax:319-832-1469
Practice Address - Street 1:6911 C AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1349
Practice Address - Country:US
Practice Address - Phone:319-832-1463
Practice Address - Fax:319-832-1469
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4111591Medicaid
IA080149543OtherRR MEDICARE
IA1336127877Medicaid
IA3111591Medicaid
IA6111591Medicaid
IA7111591Medicaid
IA5111591Medicaid
IA4111591Medicaid
IA7111591Medicaid