Healthcare Provider Details

I. General information

NPI: 1356032130
Provider Name (Legal Business Name): EMMA AVDIC MUSTEDANAGIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR STE 320
WATERLOO IA
50702-5620
US

IV. Provider business mailing address

1320 W LOMBARD ST
DAVENPORT IA
52804-2029
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-8072
Mailing address:
  • Phone: 563-333-5827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: