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NPI Code Detail

MEDICARE: MR. STEPHEN P DEPORTER APN

MEDICARE: MR. STEPHEN P DEPORTER APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA-081354IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1056857OTHERHEALTH ALLIANCE
2185922OTHERIOWA HEALTH SOLUTIONS
3IL01G2OTHERJOHN DEERE HEALTH PLAN
44796890020OTHERDMERC

General Provider Information

NPI Number : 1639174519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN P DEPORTER APN
Provider Business Mailing Address
First Line : 1227 E RUSHOLME ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52803-2459
Country : US
Telephone Number : 563-421-7681
Fax Number :
Provider Business Practice Location Address
First Line : 1227 E RUSHOLME ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52803-2459
Country : US
Telephone Number : 563-421-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 05/06/2021

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Directions to “ MR. STEPHEN P DEPORTER APN” Practice Location

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