Healthcare Provider Details

I. General information

NPI: 1750737169
Provider Name (Legal Business Name): STEPHANIE WESTLAKE EDMONDS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE JOYCE WESTLAKE R.N.

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CHURCH ST
IOWA CITY IA
52245-6007
US

IV. Provider business mailing address

200 NEWTON RD. 5231 WESTLAWN
IOWA CITY IA
52242
US

V. Phone/Fax

Practice location:
  • Phone: 636-541-0011
  • Fax:
Mailing address:
  • Phone: 319-335-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number123746
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: