Healthcare Provider Details

I. General information

NPI: 1497647937
Provider Name (Legal Business Name): WESTON JOSEPH BIETZ DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 AVENUE O STE 125
FORT MADISON IA
52627-9602
US

IV. Provider business mailing address

5409 AVENUE O STE 125
FORT MADISON IA
52627-9602
US

V. Phone/Fax

Practice location:
  • Phone: 319-376-1130
  • Fax: 319-376-1131
Mailing address:
  • Phone: 319-376-1130
  • Fax: 319-376-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG185776
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: