Healthcare Provider Details

I. General information

NPI: 1679132591
Provider Name (Legal Business Name): AMY MAE-ZOSS MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MAE ZOSS

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT ST STE 400
DES MOINES IA
50309-1418
US

IV. Provider business mailing address

1215 PLEASANT ST STE 400
DES MOINES IA
50309-1418
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-4019
  • Fax: 515-241-4051
Mailing address:
  • Phone: 515-241-4019
  • Fax: 515-241-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH155101
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberH155101
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberH155101
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number136771
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: