Provider Demographics
NPI:1215212865
Name:VETSCH, MICHELLE L (DNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:VETSCH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 WILLIAMS BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-368-8400
Mailing Address - Fax:319-368-8405
Practice Address - Street 1:4325 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-368-8400
Practice Address - Fax:563-264-9195
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA117470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2621009Medicare PIN