Healthcare Provider Details

I. General information

NPI: 1720681554
Provider Name (Legal Business Name): COURTNEY MAKUS AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVCENUE
AMES IA
50010
US

IV. Provider business mailing address

5211 NW 8TH ST
ANKENY IA
50023-8013
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4472
  • Fax: 515-239-4539
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH159470
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH159470
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberH159470
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: