Healthcare Provider Details

I. General information

NPI: 1841972825
Provider Name (Legal Business Name): EMILY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY DR STE 201
DUBUQUE IA
52001-7300
US

IV. Provider business mailing address

200 MERCY DR STE 201
DUBUQUE IA
52001-7300
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-3500
  • Fax: 563-584-3520
Mailing address:
  • Phone: 563-584-3500
  • Fax: 563-584-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberG175630
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: