Basic Information
Provider Information
NPI: 1588999114
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOTTENFIELD-BIEHN
FirstName: JESSICA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: ARNP/CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 UNIVERSITY AVE STE 200
Address2:  
City: DES MOINES
State: IA
PostalCode: 503142355
CountryCode: US
TelephoneNumber: 5152481447
FaxNumber: 5152481440
Practice Location
Address1: 3509 E 29TH ST
Address2:  
City: DES MOINES
State: IA
PostalCode: 503174253
CountryCode: US
TelephoneNumber: 5152481600
FaxNumber: 5152481610
Other Information
ProviderEnumerationDate: 10/15/2009
LastUpdateDate: 06/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XB110659IAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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