Provider Demographics
NPI:1952304255
Name:VOGELER, STEPHANIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:VOGELER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 ATLANTIC DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-8950
Mailing Address - Country:US
Mailing Address - Phone:319-396-2000
Mailing Address - Fax:319-396-5567
Practice Address - Street 1:9255 ATLANTIC DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-8950
Practice Address - Country:US
Practice Address - Phone:319-396-2000
Practice Address - Fax:319-396-5567
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001431363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00993443OtherRR MEDICARE
IA1952304255Medicaid
IAP67704Medicare UPIN
IA1952304255Medicaid
IA719260241Medicare PIN
IA0363070001Medicare PIN
IA970027658Medicare PIN