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KRISTINE M STAHELI JACKSON

Non-Pharmacy Dispensing Site

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

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Contact Information

KRISTINE M STAHELI JACKSON
HILLCREST FAMILY SERVICES CLINIC
220 W 7TH ST
DUBUQUE, IA  52001
 Phone: 563-583-6431
 Fax: 563-557-4447
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Non-Pharmacy Dispensing Site

 332900000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for KRISTINE M STAHELI JACKSON

NPI Number 1205847845
LBN Legal business name KRISTINE M STAHELI JACKSON
Authorized official GARY GANSEMER - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/10/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
IA License # F066142
IA Medicaid 0140087
Other 1621653 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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