Provider Demographics
NPI:1861777922
Name:STANIFORTH, KATHARINE MARY (KATHARINE STANIFORTH)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:MARY
Last Name:STANIFORTH
Suffix:
Gender:F
Credentials:KATHARINE STANIFORTH
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:MARY
Other - Last Name:NUZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2301 STEINDLER WAY STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-7907
Mailing Address - Country:US
Mailing Address - Phone:319-338-3606
Mailing Address - Fax:319-338-0522
Practice Address - Street 1:2301 STEINDLER WAY STE B
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-7907
Practice Address - Country:US
Practice Address - Phone:319-338-3606
Practice Address - Fax:319-338-0522
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-119429363LA2200X
IAH119429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA119429OtherSTATE LICENSE