Provider Demographics
NPI:1720746795
Name:SWON, STACY LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SWON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 S GEAR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-753-5177
Mailing Address - Fax:
Practice Address - Street 1:1223 S GEAR AVE STE 108
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-753-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC166164363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics