Individual provider Active NPI

Cristina Lynn Holtorf, MSN, ARNP, FNP-BC

  • Nurse Practitioner
  • Waukee, IA
National Provider Identifier
1790440808
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A166335 Issued in IA
Practice address
830 NE Alices Rd
Waukee, IA 50263-8857
Phone
(515) 875-9610
Fax
(515) 875-9611
NPI assigned
Nov 3, 2021
Last updated
Dec 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A166335 IA Primary

Addresses

Primary practice location

830 NE Alices Rd
Waukee, IA 50263-8857

Mailing address

PO Box 424
Des Moines, IA 50302-0424
Phone (515) 875-9255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211217001357 IA Practitioner - Nurse Practitioner 8123419694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Iowa Clinic PCGroup PAC ID 4082513742, 307 clinicians

Practice addresses (Care Compare)

830 NE Alices Rd
Waukee, IA 50263-8857
Phone (515) 875-9100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A166335IAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Iowa Clinic PC CurrentSince Jan 31, 2022 Accepting new patients
The Iowa Clinic, PC CurrentSince Jan 31, 2022 Accepting new patients

Locations

1005 Pennsylvania Ave
Ste 102A
Ottumwa, IA 52501
Phone (641) 684-2589

830 NE Alices Rd
Waukee, IA 50263
Phone (515) 875-9610

5950 University Ave
West Des Moines, IA 50266
Phone (515) 412-5112

5950 University Ave
Ste 136
West Des Moines, IA 50266
Phone (515) 875-9766

Interoperability endpoints

  • Direct secure messaging: cristinaholtorf@tic.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1790440808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 424",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503020424",
            "telephone_number": "515-875-9255",
            "fax_number": "515-875-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 NE ALICES RD",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502638857",
            "telephone_number": "515-875-9610",
            "fax_number": "515-875-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTORF",
        "first_name": "CRISTINA",
        "middle_name": "LYNN",
        "credential": "MSN, ARNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A166335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukee, IA

Sources for this page

Verify at the official NPI Registry.