Provider Demographics
NPI:1649385246
Name:STECKER, CONCESSA LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:CONCESSA
Middle Name:LOUISE
Last Name:STECKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CONCESSA
Other - Middle Name:LOUISE
Other - Last Name:ASHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 PLEASANT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5653
Mailing Address - Country:US
Mailing Address - Phone:563-332-1543
Mailing Address - Fax:
Practice Address - Street 1:1441 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1707
Practice Address - Country:US
Practice Address - Phone:563-888-6275
Practice Address - Fax:563-884-4638
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAZ-091505364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
07452011Medicare PIN