Provider Demographics
NPI:1134231459
Name:GRACE V HATCHER
Entity type:Organization
Organization Name:GRACE V HATCHER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:VENTIMIGLIA
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, MSN, CS
Authorized Official - Phone:515-277-7370
Mailing Address - Street 1:2213 GRAND AVE
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 1:520 42ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2757
Practice Address - Country:US
Practice Address - Phone:515-277-7370
Practice Address - Fax:515-277-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT-061905363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA049920Medicaid
IAS01255Medicare UPIN
IAI18947Medicare PIN