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General NPI Number Information
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NPI Number | 1760016786
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Entity Type | Organization
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Legal Business Name | MINDY JO ROBERTS INC
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 2600 DODGE ST STE D4
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City | DUBUQUE
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State | IA
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Zip | 52003-7161
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Country | US
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Telephone | 563-590-6597
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Fax |
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Provider Business Mailing Address
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Address Line | 15740 N CASCADE RD
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City | PEOSTA
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State | IA
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Zip | 52068-7027
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Country | US
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Telephone | 563-590-6597
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MINDY JO ROBERTS
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Credential | ARNP
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Telephone | 563-590-6597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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