Healthcare Provider Details

I. General information

NPI: 1376993709
Provider Name (Legal Business Name): STEPHANIE ELLSWORTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 N PORT DR STE 100
MUSCATINE IA
52761-2242
US

IV. Provider business mailing address

200 HAWKINS DRIVE DEPARTMENT OF INTERNAL MEDICINE
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 563-262-4101
  • Fax:
Mailing address:
  • Phone: 319-356-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA132211
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA132211
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: