Individual
BETSY LUCILLE VAN HAAFTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5705 NW 100TH ST STE 100, JOHNSTON, IA 50131-1813
(515) 726-3376
(515) 446-9707
Mailing address
6500 UNIVERSITY AVE UNIT 309, DES MOINES, IA 50324-1664
(641) 780-0473
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
106508
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106508
PA LICENSE
IA
01
—
1774847
PA CERTIFICATION NUMBER
—
01
—
362EA3363
DRIVER'S LISENCE
IA
Enumeration date
01/27/2021
Last updated
01/11/2023
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