Healthcare Provider Details

I. General information

NPI: 1821657966
Provider Name (Legal Business Name): GENEVIEVE GABRIELE D'AMATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 6TH AVE STE 400
DES MOINES IA
50309-4108
US

IV. Provider business mailing address

6500 RIVER PLACE BLVD STE 102
AUSTIN TX
78730-1119
US

V. Phone/Fax

Practice location:
  • Phone: 515-864-0259
  • Fax:
Mailing address:
  • Phone: 512-717-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: