Healthcare Provider Details

I. General information

NPI: 1285308395
Provider Name (Legal Business Name): DANIELLE RAE BOUTSALIS FNP-C, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE RAE THOMAS FNP-C, ARNP

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 04/02/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST STE A250
DES MOINES IA
50314-3029
US

IV. Provider business mailing address

PO BOX 9170
DES MOINES IA
50306-9170
US

V. Phone/Fax

Practice location:
  • Phone: 515-235-5000
  • Fax: 515-288-6713
Mailing address:
  • Phone: 515-633-3600
  • Fax: 515-633-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA163581
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: