Provider Demographics
NPI:1629342662
Name:STOCKER, ROSA (ARNP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:STOCKER
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 1:3901 NE BELLAGIO CIR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6864
Mailing Address - Country:US
Mailing Address - Phone:515-865-4291
Mailing Address - Fax:515-207-9358
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:515-207-9358
Practice Address - Fax:515-207-9370
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA472239364Medicaid