Provider Demographics
NPI:1720740723
Name:STOKER, THERESA ANN (NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:STOKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 DODGE DR.
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4647
Mailing Address - Country:US
Mailing Address - Phone:319-325-2686
Mailing Address - Fax:
Practice Address - Street 1:2935 DODGE DR.
Practice Address - Street 2:UNIT 2
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5050
Practice Address - Country:US
Practice Address - Phone:319-325-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily