Provider Demographics
NPI:1295718286
Name:MITCHELL, AMY BETH (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:VANDENHULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7100
Mailing Address - Fax:515-643-7145
Practice Address - Street 1:2605 SW WHITE BIRCH DRIVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7235
Practice Address - Country:US
Practice Address - Phone:515-643-7100
Practice Address - Fax:515-643-7145
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3465195Medicaid
IA49226OtherWELLMARK BLUE SHIELD
IA14651957Medicaid
IA49226OtherWELLMARK BLUE SHIELD
IA40571Medicare UPIN