Blythe D Waltersdorf, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001293 Issued in IA

Practice address

1610 W Townline St
Suite 1
Creston, IA 50801-1066

Phone

(641) 782-2131

Fax

(641) 782-6425

NPI assigned

Sep 27, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1669468385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 W TOWNLINE ST",
            "address_2": "SUITE 1",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011066",
            "telephone_number": "641-782-2131",
            "fax_number": "641-782-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 W TOWNLINE ST",
            "address_2": "SUITE 1",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011066",
            "telephone_number": "641-782-2131",
            "fax_number": "641-782-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERSDORF",
        "first_name": "BLYTHE",
        "middle_name": "D",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Creston, IA
• Providers in Creston, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.