Provider Demographics
NPI:1245216720
Name:CAPELLA, JEANNETTE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:CAPELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:1212 PLEASANT ST STE 211
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-875-9770
Practice Address - Fax:515-875-9771
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD451582086S0102X
PAMD4420792086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010039851Medicaid
VA010050685Medicaid
VA7312971Medicaid
VA000442C19Medicare PIN
VAH29007Medicare UPIN
000442C19Medicare PIN