Healthcare Provider Details

I. General information

NPI: 1295534790
Provider Name (Legal Business Name): MARCI ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCI ELIZABETH NYSTROM

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
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: 515-664-4171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number131909
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH185229
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: