Provider Demographics
NPI:1275578320
Name:PITKIN, STEFANI K (PA-C)
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:K
Last Name:PITKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:1094 220TH ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:IA
Practice Address - Zip Code:50648-9400
Practice Address - Country:US
Practice Address - Phone:319-827-3000
Practice Address - Fax:319-827-2393
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ56997Medicare UPIN
IAI16423Medicare PIN