Individual
JASON T DEWILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5901 WESTOWN PKWY, SUITE 210, WEST DES MOINES, IA 50266-8218
(515) 221-9222
(515) 221-0575
Mailing address
5901 WESTOWN PKWY, SUITE 210, WEST DES MOINES, IA 50266-8218
(515) 221-9222
(515) 221-0575
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
DO53141
IA
367500000X
Certified Registered Nurse Anesthetist
Primary
D-097433
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0285411
—
IA
01
—
50171
GROUP MEDICARE NUMBER
IA
Enumeration date
08/16/2005
Last updated
06/29/2010
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