Provider Demographics
NPI:1346928744
Name:STOUT, ELIZABETH MAE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAE
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VAN HORNE
Mailing Address - State:IA
Mailing Address - Zip Code:52346-9740
Mailing Address - Country:US
Mailing Address - Phone:319-350-1857
Mailing Address - Fax:
Practice Address - Street 1:105 6TH ST
Practice Address - Street 2:
Practice Address - City:VAN HORNE
Practice Address - State:IA
Practice Address - Zip Code:52346-9740
Practice Address - Country:US
Practice Address - Phone:319-350-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide