Provider Demographics
NPI:1669243077
Name:WAECHTER, STEPHANIE JEAN (DNP-FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:WAECHTER
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 NW AUTUMN CREST DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4413
Mailing Address - Country:US
Mailing Address - Phone:515-393-1126
Mailing Address - Fax:
Practice Address - Street 1:728 NW AUTUMN CREST DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4413
Practice Address - Country:US
Practice Address - Phone:515-393-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA177193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine