Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34707 | IA |
NPI | 1003058280 |
---|---|
Provider Name | Jennifer D Stone |
First Address | Omaha, NE 68103-0755 |
Second Address | Council Bluffs, IA 51503-4658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2009 |
Last Update Date | 04/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003058280 | (05) | IA |
470687317-12 | (05) | NE |