Provider Demographics
NPI:1386752996
Name:STAMP, JEAN R (ARNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:STAMP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2057
Mailing Address - Country:US
Mailing Address - Phone:712-755-5161
Mailing Address - Fax:712-755-4312
Practice Address - Street 1:1220 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2009
Practice Address - Country:US
Practice Address - Phone:712-755-5130
Practice Address - Fax:712-755-4470
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0475459Medicaid
IA0475459Medicaid
IAI16420Medicare PIN