Individual
DIANE L DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
704 3RD ST, SULLY, IA 50251-1016
(641) 594-3150
(641) 594-3795
Mailing address
704 3RD ST, SULLY, IA 50251-1016
(641) 594-3150
(641) 594-3795
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001494
IA
363AM0700X
Medical Physician Assistant
001494
IA
Other
Enumeration date
01/23/2006
Last updated
08/31/2022
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