Provider Demographics
NPI:1750737169
Name:EDMONDS, STEPHANIE WESTLAKE (RN)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:WESTLAKE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JOYCE
Other - Last Name:WESTLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 NEWTON RD.
Mailing Address - Street 2:5231 WESTLAWN
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-335-9811
Mailing Address - Fax:
Practice Address - Street 1:822 CHURCH ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-6007
Practice Address - Country:US
Practice Address - Phone:636-541-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123746163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory