MEDICARE: DR. DANIELLE FITCH DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G165507	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G165507	OTHER	IA	LICENSE

General Provider Information

NPI Number	:	1124797212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE FITCH DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	5417 SE 28TH CT
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50320-2038
Country	:	US
Telephone Number	:	515-943-9695
Fax Number	:	515-644-5503

Provider Business Practice Location Address
First Line	:	800 19TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-1112
Country	:	US
Telephone Number	:	515-605-0704
Fax Number	:	515-644-5503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	04/06/2026

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