Healthcare Provider Details

I. General information

NPI: 1528587847
Provider Name (Legal Business Name): STEPHANIE WADLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 INGERSOLL AVE
DES MOINES IA
50312-5227
US

IV. Provider business mailing address

7020 NW 6TH DR
ANKENY IA
50023-8987
US

V. Phone/Fax

Practice location:
  • Phone: 515-279-6424
  • Fax:
Mailing address:
  • Phone: 515-822-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA102421
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102421A
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: