Provider Demographics
NPI:1003020496
Name:WINTERS, AMANDA JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOHNSON
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:AMANDA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1225 S GEAR AVE STE 251
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1688
Mailing Address - Country:US
Mailing Address - Phone:319-768-3700
Mailing Address - Fax:319-768-3712
Practice Address - Street 1:1225 S GEAR AVE STE 251
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1688
Practice Address - Country:US
Practice Address - Phone:319-768-3700
Practice Address - Fax:319-768-3712
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2491002084P0015X
IA413422084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090130AMedicaid