Organization
KRISTINE M STAHELI JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GANSEMER (CEO)
(563) 583-7357
Entity
Organization
Contact information
Practice address
HILLCREST FAMILY SERVICES CLINIC, 220 W 7TH ST, DUBUQUE, IA 52001
(563) 583-6431
(563) 557-4447
Mailing address
PO BOX 116, DUBUQUE, IA 52004-0116
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
F066142
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0140087
—
IA
01
—
1621653
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/10/2006
Last updated
08/22/2020
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