Healthcare Provider Details

I. General information

NPI: 1245869403
Provider Name (Legal Business Name): TESS ELISABETH DYSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESS ELISABETH NOELLER

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 06/05/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 6 W
IOWA CITY IA
52246-2209
US

IV. Provider business mailing address

603 REDBIRD RUN
TIFFIN IA
52340-9434
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-310-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number23593
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: