Healthcare Provider Details

I. General information

NPI: 1114759321
Provider Name (Legal Business Name): EMILY MILES DNP, AGACNP-BC, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MERCY DR
COUNCIL BLUFFS IA
51503-3128
US

IV. Provider business mailing address

800 MERCY DR
COUNCIL BLUFFS IA
51503-3128
US

V. Phone/Fax

Practice location:
  • Phone: 855-524-4001
  • Fax: 712-325-2499
Mailing address:
  • Phone: 855-524-4001
  • Fax: 712-325-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83031
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115503
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH183734
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: