Provider Demographics
NPI:1588656003
Name:BURMEISTER, STACEY ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ELIZABETH
Last Name:BURMEISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:ELIZABETH
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:933 E PIERCE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4626
Mailing Address - Country:US
Mailing Address - Phone:712-396-7460
Mailing Address - Fax:712-396-7465
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-7460
Practice Address - Fax:712-396-7465
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588656003Medicaid
NE10025873100Medicaid
IA1588656003OtherWELLMARK
NE10025873100Medicaid