Healthcare Provider Details

I. General information

NPI: 1255453767
Provider Name (Legal Business Name): DANA LEA HARTWIGSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA LEA LENZ DO

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVENUE
AMES IA
50010-3014
US

IV. Provider business mailing address

1215 DUFF AVENUES PO BOX 3014
AMES IA
50010-3014
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4404
  • Fax: 515-239-4721
Mailing address:
  • Phone: 515-239-4404
  • Fax: 515-239-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.120801
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04662
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: