Healthcare Provider Details

I. General information

NPI: 1053256982
Provider Name (Legal Business Name): EMRA OGLECEVAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E HICKMAN RD
WAUKEE IA
50263-8720
US

IV. Provider business mailing address

1005 E HICKMAN RD
WAUKEE IA
50263-8720
US

V. Phone/Fax

Practice location:
  • Phone: 515-447-2813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number8160
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: