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General NPI Number Information
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NPI Number | 1487051256
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Entity Type | Individual
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Provider Name | EMMA ANITA NYE DAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/22/2014
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 2507 UNIVERSITY AVE
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City | DES MOINES
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State | IA
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Zip | 50311-4516
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Country | US
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Telephone | 518-524-1753
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Fax |
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Provider Business Mailing Address
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Address Line | 3164 SW ARLAN LN
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City | ANKENY
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State | IA
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Zip | 50023-6826
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Country | US
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Telephone | 518-524-1753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 088230
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License Number State | IA
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