MEDICARE: DR. STEPHANIE LYNN COURSON POTHOVEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	DO-03795	IA

General Provider Information

NPI Number	:	1033230560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LYNN COURSON POTHOVEN DO

Provider Business Mailing Address
First Line	:	12129 UNIVERSITY AVE STE 200
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8287
Country	:	US
Telephone Number	:	515-400-3550
Fax Number	:	515-400-3551

Provider Business Practice Location Address
First Line	:	12129 UNIVERSITY AVE STE 100
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8287
Country	:	US
Telephone Number	:	515-400-3550
Fax Number	:	515-400-3551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/13/2021

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