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General NPI Number Information
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NPI Number | 1225998842
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Entity Type | Organization
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Legal Business Name | MEDICINE CREEK WELLNESS, PLLC
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Dates
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Enumeration Date | 11/15/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 406 S LINCOLN ST
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City | CORYDON
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State | IA
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Zip | 50060-1704
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Country | US
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Telephone | 641-505-1474
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Fax | 515-328-4662
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Provider Business Mailing Address
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Address Line | 406 S LINCOLN ST
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City | CORYDON
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State | IA
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Zip | 50060-1704
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Country | US
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Telephone | 641-505-1474
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Fax | 515-328-4662
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE PERKINS MAHAN
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Credential | DO
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Telephone | 641-505-1474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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