Provider Demographics
NPI:1891101457
Name:VAMPOLA-RUNYAN, STEPHANIE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:VAMPOLA-RUNYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1056
Mailing Address - Country:US
Mailing Address - Phone:712-563-4611
Mailing Address - Fax:
Practice Address - Street 1:515 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1056
Practice Address - Country:US
Practice Address - Phone:712-563-4611
Practice Address - Fax:563-742-4355
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine