Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | DO-03795 | IA |
NPI | 1033230560 |
---|---|
Provider Name | Dr. Stephanie Lynn Courson Pothoven |
First Address | Clive, IA 50325-8287 |
Second Address | Clive, IA 50325-8287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 13/09/2021 |