Basic Information
| Provider Information | |||||||||
| NPI: | 1750949111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOGDILL | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516011626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122152743 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2301 EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515661300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7126237000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2019 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A154701 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.