=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760032569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE N MUNIER AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2019
-----------------------------------------------------
Last Update Date | 08/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616 CEDAR ST
-----------------------------------------------------
City | MUSCATINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52761-3453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-263-3921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2451 WOOD LILY RDG
-----------------------------------------------------
City | MUSCATINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52761-8449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-415-6498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | H156066
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------