Provider Demographics
NPI:1528543311
Name:GRARUP, EMILY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:GRARUP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 LOGAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1002
Mailing Address - Country:US
Mailing Address - Phone:319-226-8430
Mailing Address - Fax:319-226-8435
Practice Address - Street 1:2140 LOGAN AVE STE C
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1002
Practice Address - Country:US
Practice Address - Phone:319-226-8430
Practice Address - Fax:319-226-8435
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA142410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily