Provider Demographics
NPI:1528533056
Name:DOHLMAN, JACLYN MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:DOHLMAN
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 1:54 FOUR WINDS DR
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1102
Mailing Address - Country:US
Mailing Address - Phone:507-990-4766
Mailing Address - Fax:
Practice Address - Street 1:401 S 17TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2304
Practice Address - Country:US
Practice Address - Phone:641-357-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA143536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily