Provider Demographics
NPI:1356329130
Name:WADLE-WIGNALL, STEPHANIE D (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:WADLE-WIGNALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 SW ORALABOR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7004
Mailing Address - Country:US
Mailing Address - Phone:515-964-4600
Mailing Address - Fax:515-964-9838
Practice Address - Street 1:909 SW ORALABOR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7004
Practice Address - Country:US
Practice Address - Phone:515-964-4600
Practice Address - Fax:515-964-9838
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022026243208000000X
IA33362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1356329130Medicaid
IA1356329130Medicaid
IAI16002Medicare PIN