Provider Demographics
NPI:1033777610
Name:PURSLEY, EMILY ROSE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:PURSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NE IA FAMILY PRACTICE CENTER
Mailing Address - Street 2:2055 KIMBALL AVE. STE. 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702
Mailing Address - Country:US
Mailing Address - Phone:319-272-2112
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL ARTS BLDG.
Practice Address - Street 2:2055 KIMBALL AVE. SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5070
Practice Address - Country:US
Practice Address - Phone:319-272-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine