Healthcare Provider Details

I. General information

NPI: 1821757519
Provider Name (Legal Business Name): STEPHANIE NICHOLE JOHNSON A.R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NICHOLE MONTGOMERY

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S. GEAR AVE
WEST BURLINGTON IA
52655
US

IV. Provider business mailing address

1221 S GEAR AVE
WEST BURLINGTON IA
52655-1681
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4320
  • Fax:
Mailing address:
  • Phone: 319-768-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA166583
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: