Provider Demographics
NPI:1992946172
Name:WEBNER, STACIE (NP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WEBNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4705
Mailing Address - Country:US
Mailing Address - Phone:712-276-2467
Mailing Address - Fax:712-276-2062
Practice Address - Street 1:4500 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4705
Practice Address - Country:US
Practice Address - Phone:712-276-2467
Practice Address - Fax:712-276-2062
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-099019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily