Provider Demographics
NPI:1841546512
Name:EMBRETSON, STACEY ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:EMBRETSON
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 1:911 CARTER ST NW
Mailing Address - Street 2:
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-9016
Mailing Address - Country:US
Mailing Address - Phone:563-245-1717
Mailing Address - Fax:563-245-2066
Practice Address - Street 1:911 CARTER ST NW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9016
Practice Address - Country:US
Practice Address - Phone:563-245-1717
Practice Address - Fax:563-245-2066
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA110842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner