Provider Demographics
NPI:1447781448
Name:MOON, STEPHANIE (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-4704
Mailing Address - Country:US
Mailing Address - Phone:319-248-0037
Mailing Address - Fax:319-887-2944
Practice Address - Street 1:2055 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-4704
Practice Address - Country:US
Practice Address - Phone:319-248-0037
Practice Address - Fax:319-887-2944
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA131906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily