Basic Information
| Provider Information | |||||||||
| NPI: | 1033230560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURSON POTHOVEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
| FaxNumber: | 5154003551 | ||||||||
| Practice Location | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
| FaxNumber: | 5154003551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | DO-03795 | IA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.