Healthcare Provider Details

I. General information

NPI: 1952312985
Provider Name (Legal Business Name): DAUNYALE L SPORAA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 1ST ST
EMMETSBURG IA
50536-2516
US

IV. Provider business mailing address

600 1ST ST NW SUITE 101
MASON CITY IA
50401-2932
US

V. Phone/Fax

Practice location:
  • Phone: 712-852-5555
  • Fax: 712-852-5692
Mailing address:
  • Phone: 641-428-3041
  • Fax: 641-428-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03148
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: