Healthcare Provider Details

I. General information

NPI: 1245547983
Provider Name (Legal Business Name): QUENTIN EUGENE STENGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LAFAYETTE RD
EVANSDALE IA
50707-1129
US

IV. Provider business mailing address

3701 LAFAYETTE RD
EVANSDALE IA
50707-1129
US

V. Phone/Fax

Practice location:
  • Phone: 319-274-7060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002136
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: