Provider Demographics
NPI:1366504813
Name:ARTZ, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ARTZ
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 1:1221 PLEASANT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1424
Mailing Address - Country:US
Mailing Address - Phone:515-241-8221
Mailing Address - Fax:515-241-4001
Practice Address - Street 1:1221 PLEASANT ST STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1424
Practice Address - Country:US
Practice Address - Phone:515-241-8221
Practice Address - Fax:515-241-4001
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107026207R00000X
IA40355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01266133OtherRR MEDICARE
IL036107026Medicaid
IA1366504813Medicaid
IA1366504813Medicaid
IAI22140009Medicare PIN