Basic Information
Provider Information | |||||||||
NPI: | 1770695827 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAHONEY | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | JUNE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WOOD | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193536314 | ||||||||
FaxNumber: | 3193537788 | ||||||||
Practice Location | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193536314 | ||||||||
FaxNumber: | 3193537788 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 02/04/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F4007271 | NY | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LP0808X | G116536 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
ID | Type | State | Issuer | Description | 536497 | 01 |   | CDPHP | OTHER | 7348759 | 01 |   | VALUEOPTIONS - EMPIRE GHI | OTHER | 1033150 | 01 |   | BEACON HEALTH STRAT | OTHER | 370612 | 01 |   | MVP HEALTH CARE | OTHER | 536497 | 01 |   | VALUEOPTIONS | OTHER | 7293684 | 01 |   | AETNA | OTHER | 2238578 | 01 |   | CIGNA BEH HEALTH | OTHER | 560713000 | 01 |   | MAGELLAN | OTHER |