Healthcare Provider Details

I. General information

NPI: 1205672946
Provider Name (Legal Business Name): JOYCIN NICOLE STONACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42ND AND EMILE
OMAHA NE
68198-0001
US

IV. Provider business mailing address

800 MERCY DR STE 5
COUNCIL BLUFFS IA
51503-3128
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4000
  • Fax:
Mailing address:
  • Phone: 402-717-6870
  • Fax: 402-717-6874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3363
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number137884
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: