MEDICARE: DR. EMMA ANITA NYE DAT, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	088230	IA

General Provider Information

NPI Number	:	1487051256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMA ANITA NYE DAT, LAT, ATC

Provider Business Mailing Address
First Line	:	3164 SW ARLAN LN
Second Line	:
City	:	ANKENY
State	:	IA
Zip	:	50023-6826
Country	:	US
Telephone Number	:	518-524-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 UNIVERSITY AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-4516
Country	:	US
Telephone Number	:	518-524-1753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	03/18/2020

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