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5408 Nw 88th St Ste 140 Johnston IA 50131-2953 | |
| (515) 368-7504 | |
| (515) 355-3491 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 5408 Nw 88th St Ste 140, Johnston, Iowa |
| Authorized Official Name and Position | Hillary Chidester (OFFICE MANAGER) |
| Authorized Official Contact | 5153687504 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5408 Nw 88th St Ste 140 Johnston IA 50131-2953 Ph: (515) 368-7504 | 5408 Nw 88th St Ste 140 Johnston IA 50131-2953 Ph: (515) 368-7504 |
| NPI Number | 1245833565 |
|---|---|
| Provider Enumeration Date | 11/19/2020 |
| Last Update Date | 08/14/2024 |
| Certification Date | 08/14/2024 |
| Medicare PECOS PAC ID | 5496168882 |
|---|---|
| Medicare Enrollment ID | O20210104000116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245833565 | NPI | - | NPPES |
| Provider Name | Holly J Lukasiewicz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669887469 PECOS PAC ID: 6406122118 Enrollment ID: I20171025001097 |
| Provider Name | Lorraine Chidester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477019446 PECOS PAC ID: 6305259797 Enrollment ID: I20210104000201 |
| Provider Name | Erin L Fox-hammel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609532373 PECOS PAC ID: 1850784331 Enrollment ID: I20220204000883 |
| Provider Name | Haley Lynn Kloberdanz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104553304 PECOS PAC ID: 6901267988 Enrollment ID: I20230808000251 |
| Provider Name | Miranda Engeldinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699456087 PECOS PAC ID: 6406210079 Enrollment ID: I20230914003512 |
| Provider Name | Kirsten Just |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447684865 PECOS PAC ID: 6002264249 Enrollment ID: I20231128002380 |
| Provider Name | Samantha Alexis Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629696893 PECOS PAC ID: 1355790692 Enrollment ID: I20231212000462 |
| Provider Name | Andrea Judkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457036444 PECOS PAC ID: 1355887779 Enrollment ID: I20240722003503 |
| Provider Name | Hilliary Mahler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275380115 PECOS PAC ID: 8527504661 Enrollment ID: I20240724003644 |
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