Joellen Cizek Kubik, ARNP; PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

067317 Issued in IA

Practice address

146 W Dale St
Suite 101
Waterloo, IA 50703-1901

Phone

(319) 233-3351

Fax

(319) 235-3132

NPI assigned

Aug 22, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1154637692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "SUITE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-233-3351",
            "fax_number": "319-235-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "SUITE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-233-3351",
            "fax_number": "319-235-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIK",
        "first_name": "JOELLEN",
        "middle_name": "CIZEK",
        "name_prefix": "Ms.",
        "credential": "ARNP; PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-22",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "067317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "533820005",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.