Healthcare Provider Details

I. General information

NPI: 1952007775
Provider Name (Legal Business Name): KELENE MARIE WESTENDORF ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-3057
  • Fax: 515-643-0943
Mailing address:
  • Phone: 515-247-3057
  • Fax: 515-643-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA172790
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA172790
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: