Provider Demographics
NPI:1578056859
Name:O'BRIEN, STEPHANIE D (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:LEEDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7337
Mailing Address - Fax:515-222-7340
Practice Address - Street 1:1601 NW 114TH ST STE 345
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7036
Practice Address - Country:US
Practice Address - Phone:515-222-7337
Practice Address - Fax:515-222-7340
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125072406208000000X
IADO-05758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics