Provider Demographics
NPI:1316911803
Name:JACH, PAMELA J (CNM)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:JACH
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 79TH PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2672
Mailing Address - Country:US
Mailing Address - Phone:515-490-8484
Mailing Address - Fax:
Practice Address - Street 1:763 79TH PL
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2672
Practice Address - Country:US
Practice Address - Phone:515-490-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB100865367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1420380Medicaid
IA0420380Medicaid
IAI11343Medicare ID - Type Unspecified
IA1420380Medicaid
IAI2214005Medicare UPIN