Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4446 | IA |
Y | 2080P0006X | Developmental - Behavioral Pediatrician | 4446 | IA |
N | 2080P0204X | Pediatric Emergency Doctor | 04446 | IA |
NPI | 1215223847 |
---|---|
Provider Name | Michelle M Ewest |
First Address | Des Moines, IA 50314 |
Second Address | West Des Moines, IA 50266-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215223847 | (05) | IA |
175150177 | MEDICARE (01) | IA |