Basic Information
| Provider Information | |||||||||
| NPI: | 1972162519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICKTHORN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NOYES | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR DEPT FAMILY | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076763720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR DEPT FAMILY | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193847222 | ||||||||
| FaxNumber: | 3193847822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2019 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0000X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | 207QA0401X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0505X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QB0002X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine | 207QG0300X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207QS0010X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS1201X | R-11481 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 207Q00000X | R-11481 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.