=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952518771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE A. STALLBAUMER L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 05/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 431 S DUFF AVE STE B
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-232-2979
-----------------------------------------------------
Fax | 515-232-2979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 431 S DUFF AVE STE B
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-232-2979
-----------------------------------------------------
Fax | 515-232-2979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | A-7
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------