Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | DO-05033 | IA |
Y | 2080P0210X | Pediatric Nephrologist | DO-05033 | IA |
NPI | 1235497090 |
---|---|
Provider Name | Stephanie Jane Houston |
First Address | Iowa City, IA 52242-1009 |
Second Address | Johnston, IA 50131-8821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 27/07/2021 |