Healthcare Provider Details

I. General information

NPI: 1073254439
Provider Name (Legal Business Name): MS. EMILY NANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 W BROADWAY STE 100
COUNCIL BLUFFS IA
51501-3291
US

IV. Provider business mailing address

3434 W BROADWAY STE 100
COUNCIL BLUFFS IA
51501-3291
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-0022
  • Fax:
Mailing address:
  • Phone: 712-325-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA174602
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114078
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: