Provider Demographics
NPI:1639593767
Name:JOHNSON, STEPHANIE D (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:JOHNSON
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 1:1515 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6676
Mailing Address - Country:US
Mailing Address - Phone:563-242-9355
Mailing Address - Fax:
Practice Address - Street 1:1515 21ST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6676
Practice Address - Country:US
Practice Address - Phone:563-242-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA115696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily