Provider Demographics
NPI:1093732828
Name:GATICA, STEFANIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:
Last Name:GATICA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SW PLAZA SHOPS LN STE A
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7168
Mailing Address - Country:US
Mailing Address - Phone:515-965-5677
Mailing Address - Fax:515-965-5677
Practice Address - Street 1:1850 SW PLAZA SHOPS LN STE A
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7168
Practice Address - Country:US
Practice Address - Phone:515-965-5677
Practice Address - Fax:515-965-4343
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093449163W00000X
IAA093449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI20404Medicare PIN