Healthcare Provider Details

I. General information

NPI: 1790610590
Provider Name (Legal Business Name): EMILY ANN DERMODY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 NW 124TH ST
CLIVE IA
50325-8151
US

IV. Provider business mailing address

1378 NW 124TH ST
CLIVE IA
50325-8151
US

V. Phone/Fax

Practice location:
  • Phone: 515-288-6097
  • Fax: 515-288-8335
Mailing address:
  • Phone: 515-288-6097
  • Fax: 515-288-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA191868
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: