Provider Demographics
NPI:1215700851
Name:SHONKA, NOAH ANDREW
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:ANDREW
Last Name:SHONKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-9641
Mailing Address - Country:US
Mailing Address - Phone:319-389-0018
Mailing Address - Fax:
Practice Address - Street 1:WEST TOWN CENTER, 3500 DALTON WY
Practice Address - Street 2:SUITE 400
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-369-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA176878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily