Provider Demographics
NPI:1750652657
Name:NOTHDURFT STAPLES, AMY ELIZABETH (BS, IADC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:NOTHDURFT STAPLES
Suffix:
Gender:F
Credentials:BS, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8527 UNIVERSITY BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1069
Mailing Address - Country:US
Mailing Address - Phone:515-321-6918
Mailing Address - Fax:
Practice Address - Street 1:8527 UNIVERSITY BLVD STE 9
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1069
Practice Address - Country:US
Practice Address - Phone:515-402-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)