Amanda J Vanden Wynboom, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A125509 Issued in IA

Practice address

1606 Golden Aspen Dr Ste 105
Ames, IA 50010-8011

Phone

(515) 620-5892

Fax

(515) 620-5893

NPI assigned

Aug 8, 2017

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1902321110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 RIDGETOP DR",
            "city": "HUXLEY",
            "state": "IA",
            "postal_code": "501244704",
            "telephone_number": "641-485-8164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 GOLDEN ASPEN DR STE 105",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500108011",
            "telephone_number": "515-620-5892",
            "fax_number": "515-620-5893"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14121 Parke Long Ct",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201511647",
            "country_code": "US",
            "telephone_number": "641-485-8164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDEN WYNBOOM",
        "first_name": "AMANDA J",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-08",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A125509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0227735",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IOWA",
            "identifier": "C00000057738",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Gerard Ulveling, M.D.
• Gregory R. Utesch, M.D.
• Kylee Jean Valencia
• Shannon Alexandra Van Beest
• Amanda Van Wyk, AGNP-C
• Taylor Haazen Gerardus Vanden Wynboom, D.C.
• Mark Thomas Vandenberg, MD
• Jacobus Vandeneijkhoff
• Colton Vander Berg, DPT
• Joshua Vander Zwaag, LISW

• Family Nurse Practitioner in Ames, IA
• Providers in Ames, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.