Healthcare Provider Details

I. General information

NPI: 1184585564
Provider Name (Legal Business Name): MRS. STEFANIE JO FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 VALLEY VIEW DR
CEDAR RAPIDS IA
52404-7165
US

IV. Provider business mailing address

5101 VALLEY VIEW DR
CEDAR RAPIDS IA
52404-7165
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-338-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number122392
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122392
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number122392
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: