Provider Demographics
NPI:1023609690
Name:VAN HAAFTEN, BETSY LUCILLE (PA-C)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:LUCILLE
Last Name:VAN HAAFTEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 UNIVERSITY AVE UNIT 309
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1664
Mailing Address - Country:US
Mailing Address - Phone:641-780-0473
Mailing Address - Fax:
Practice Address - Street 1:5705 NW 100TH ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1813
Practice Address - Country:US
Practice Address - Phone:515-726-3376
Practice Address - Fax:515-446-9707
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA362EA3363OtherDRIVER'S LISENCE
1774847OtherPA CERTIFICATION NUMBER
IA106508OtherPA LICENSE