Provider Demographics
NPI:1629331848
Name:STUKENHOLTZ, MEGAN L (ARNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:STUKENHOLTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 100TH ST # 113
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3860
Mailing Address - Country:US
Mailing Address - Phone:515-344-7755
Mailing Address - Fax:515-809-3855
Practice Address - Street 1:2815 100TH ST # 113
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3860
Practice Address - Country:US
Practice Address - Phone:515-344-7755
Practice Address - Fax:515-809-3855
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118802363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1629331848Medicaid
IAP01353127OtherRR MEDICARE
IA719260628Medicare PIN