Healthcare Provider Details

I. General information

NPI: 1003020496
Provider Name (Legal Business Name): AMANDA JOHNSON WINTERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH AMANDA JOHNSON MD

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 251
WEST BURLINGTON IA
52655-1688
US

IV. Provider business mailing address

1225 S GEAR AVE STE 251
WEST BURLINGTON IA
52655-1688
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3700
  • Fax: 319-768-3712
Mailing address:
  • Phone: 319-768-3700
  • Fax: 319-768-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number249100
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number41342
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: