Healthcare Provider Details

I. General information

NPI: 1922458629
Provider Name (Legal Business Name): STEPHANIE ROSE MUELLER WINNIKE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

IV. Provider business mailing address

901 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6900
  • Fax:
Mailing address:
  • Phone: 319-398-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number078031
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number077010
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: