Provider Demographics
NPI:1255453767
Name:HARTWIGSEN, DANA LEA (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LEA
Last Name:HARTWIGSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEA
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1215 DUFF AVENUES
Mailing Address - Street 2:PO BOX 3014
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4404
Mailing Address - Fax:515-239-4721
Practice Address - Street 1:1215 DUFF AVENUE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4404
Practice Address - Fax:515-239-4721
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120801208000000X
IA04662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL962341Medicare PIN