Provider Demographics
NPI:1356640031
Name:MYER, EMILY NICOLE BERNICE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:NICOLE BERNICE
Last Name:MYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1687 WOODLANE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3046
Mailing Address - Country:US
Mailing Address - Phone:651-209-6263
Mailing Address - Fax:651-348-8783
Practice Address - Street 1:1687 WOODLANE DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3046
Practice Address - Country:US
Practice Address - Phone:651-600-3035
Practice Address - Fax:651-348-8783
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079300207V00000X
MN63455207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology