Doctor Name: | STEPHANIE RAE TAETS |
NPI Number: | 1780090597 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | A112793 |
Business Practice Address: | 801 13th St Charles City, IA - 506163443 |
Business Phone Number: | 6412281143 |
Business Fax Number: | 6412287621 |
Mailing Address: | 129 Cedar St, OSAGE |
State: | IA |
Postal Code: | 504612024 |
Phone Number: | 6418328179 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2014 |
NPI Last Update Date: | 07/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A112793 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |