Provider Demographics
NPI:1306146063
Name:MATTINGLY, EMILY MARIE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARIE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2229
Mailing Address - Fax:319-384-7452
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2229
Practice Address - Fax:319-384-7452
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC157736363L00000X, 363LP0200X, 363LN0005X
TX742033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics