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General NPI Number Information
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NPI Number | 1306244934
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Entity Type | Organization
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Legal Business Name | PRIMELIFE, LLC
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Dates
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Enumeration Date | 12/13/2014
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 2610 NORTHRIDGE PKWY STE 103
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City | AMES
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State | IA
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Zip | 50010-4088
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Country | US
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Telephone | 515-292-4845
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Fax | 515-303-2291
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Provider Business Mailing Address
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Address Line | 2610 NORTHRIDGE PKWY STE 103
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City | AMES
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State | IA
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Zip | 50010-4088
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Country | US
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Telephone | 515-292-4845
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Fax | 515-303-2291
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MELANIE LINN SPENCER
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Credential | PA-C
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Telephone | 515-292-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001669
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License Number State | IA
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