MEDICARE: STEPHANIE RENEE CHRISTIAN DNP

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	363LA2100X	Acute Care Nurse Practitioner	H173258	IA
2	363LA2200X	Adult Health Nurse Practitioner	H173258	IA
3	363LG0600X	Gerontology Nurse Practitioner	H173258	IA
4	363LF0000X	Family Nurse Practitioner	H173258	IA

General Provider Information

NPI Number	:	1487354064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RENEE CHRISTIAN DNP

Provider Business Mailing Address
First Line	:	14502 CATALPA DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50323-3401
Country	:	US
Telephone Number	:	515-339-5287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 W LAKES PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8377
Country	:	US
Telephone Number	:	515-241-3510
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	11/15/2024

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