Healthcare Provider Details

I. General information

NPI: 1417523192
Provider Name (Legal Business Name): EMILY SWARTLEY PMHNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 W 9TH ST
WATERLOO IA
50702-5310
US

IV. Provider business mailing address

3251 W 9TH ST
WATERLOO IA
50702-5310
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-2893
  • Fax:
Mailing address:
  • Phone: 319-234-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG163681
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number096159
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: