Provider Demographics
NPI:1417959032
Name:HATCHER, GRACE VENTIMIGLIA (ARNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:VENTIMIGLIA
Last Name:HATCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:MARIE
Other - Last Name:VENTIMIGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2213 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1001 OFFICE PARK RD
Practice Address - Street 2:SUITE 113
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2587
Practice Address - Country:US
Practice Address - Phone:515-277-7370
Practice Address - Fax:515-277-0102
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT061905363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1932468634Medicaid
IAP01215474OtherRR MEDICARE
IA1932468634OtherBCBS
IA1932468634Medicaid