| Statera Llc | |
|
3375 Lake Ridge Drive Dubuque IA 52003 | |
| (563) 580-0243 | |
| Not Available |
| Full Name | Statera Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3375 Lake Ridge Drive, Dubuque, Iowa |
| Authorized Official Name and Position | Nicole Lee Hutchison (OWNER) |
| Authorized Official Contact | 5635800243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Statera Llc 3375 Lake Ridge Drive Dubuque IA 52003 Ph: (563) 580-0243 | Statera Llc 3375 Lake Ridge Drive Dubuque IA 52003 Ph: (563) 580-0243 |
| NPI Number | 1689172751 |
|---|---|
| Provider Enumeration Date | 01/24/2018 |
| Last Update Date | 01/24/2018 |
| Medicare PECOS PAC ID | 3476950056 |
|---|---|
| Medicare Enrollment ID | O20210923003325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689172751 | NPI | - | NPPES |
| Provider Name | Katherine T Gansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609024652 PECOS PAC ID: 1759459100 Enrollment ID: I20081013000049 |
| Provider Name | Lawrence Ronald Hutchison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639142805 PECOS PAC ID: 1658302096 Enrollment ID: I20101005001289 |
| Provider Name | Amy M Mcfadden-decker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073736518 PECOS PAC ID: 7416355581 Enrollment ID: I20211005001278 |
| Provider Name | Emily A Roling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174139315 PECOS PAC ID: 5597163220 Enrollment ID: I20211012000281 |
| Provider Name | Lynn M Randall |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316058506 PECOS PAC ID: 9739140047 Enrollment ID: I20211119001722 |
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