Healthcare Provider Details

I. General information

NPI: 1750652657
Provider Name (Legal Business Name): AMY ELIZABETH NOTHDURFT STAPLES BS, IADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 UNIVERSITY BLVD STE 9
CLIVE IA
50325-1069
US

IV. Provider business mailing address

8527 UNIVERSITY BLVD STE 9
CLIVE IA
50325-1069
US

V. Phone/Fax

Practice location:
  • Phone: 515-402-5422
  • Fax:
Mailing address:
  • Phone: 515-321-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11142
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: