Healthcare Provider Details

I. General information

NPI: 1407521164
Provider Name (Legal Business Name): JODI DALE STILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI DALE HOWARD CNP

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 19TH ST SW
MASON CITY IA
50401-6436
US

IV. Provider business mailing address

2431 WILEY BLVD SW # 1013
CEDAR RAPIDS IA
52404-6003
US

V. Phone/Fax

Practice location:
  • Phone: 319-666-4224
  • Fax:
Mailing address:
  • Phone: 775-981-0217
  • Fax: 877-384-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA164473
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA16443
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: