Provider Demographics
NPI:1447781448
Name:MOON, STEPHANIE (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 LININGER LN STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-2336
Mailing Address - Country:US
Mailing Address - Phone:319-665-3053
Mailing Address - Fax:319-665-3985
Practice Address - Street 1:1765 LININGER LN STE 1
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2336
Practice Address - Country:US
Practice Address - Phone:319-665-3053
Practice Address - Fax:319-665-3985
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA131906207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine