MEDICARE: GRACE V HATCHER ARNP PC

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	T-061905	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1932468634	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1932468634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE V HATCHER ARNP PC

Provider Business Mailing Address
First Line	:	2213 GRAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-5305
Country	:	US
Telephone Number	:	515-237-3974
Fax Number	:	515-288-0122

Provider Business Practice Location Address
First Line	:	1001 OFFICE PARK RD
Second Line	:	SUITE 113
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2587
Country	:	US
Telephone Number	:	515-277-7370
Fax Number	:	515-277-0102

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRACE VENTIMIGLIA HATCHER
Credential	:	ARNP, MSN, CS
Telephone Number	:	515-277-7370

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	08/05/2014

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