Provider Demographics
NPI:1255320081
Name:CRANE, AMY C (PAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:CRANE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-974-0800
Mailing Address - Fax:515-974-0801
Practice Address - Street 1:9421 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-2338
Practice Address - Country:US
Practice Address - Phone:515-974-0800
Practice Address - Fax:515-974-0801
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM1117969OtherFED DEA
IA5100830OtherST DEA
Q14560Medicare UPIN
Q14560Medicare UPIN