Provider Demographics
NPI:1124004536
Name:APPLETON, EMILY (PAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:APPLETON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VIRGIL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1589
Mailing Address - Country:US
Mailing Address - Phone:319-895-8841
Mailing Address - Fax:319-895-8477
Practice Address - Street 1:200 VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1589
Practice Address - Country:US
Practice Address - Phone:319-895-8841
Practice Address - Fax:319-895-8477
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS98165Medicare UPIN
IA13330Medicare ID - Type Unspecified