Provider Demographics
NPI:1659364776
Name:KLEESE, AMANDA C (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:KLEESE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-0909
Mailing Address - Country:US
Mailing Address - Phone:319-653-7291
Mailing Address - Fax:319-653-7440
Practice Address - Street 1:1230 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1144
Practice Address - Country:US
Practice Address - Phone:319-653-7291
Practice Address - Fax:319-653-7440
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC103068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0430876Medicaid
IA36094OtherWELLMARK BCBS
IA0430876Medicaid
Q04808Medicare UPIN