Healthcare Provider Details

I. General information

NPI: 1770393522
Provider Name (Legal Business Name): MAIN STREET FAMILY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
AMES IA
50010-6189
US

IV. Provider business mailing address

300 MAIN ST
AMES IA
50010-6189
US

V. Phone/Fax

Practice location:
  • Phone: 515-393-1898
  • Fax: 515-329-9174
Mailing address:
  • Phone: 515-393-1898
  • Fax: 515-329-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRITTNI REIFSCHNEIDER
Title or Position: OWNER, ARNP
Credential: ARNP
Phone: 515-393-1898