Provider Demographics
NPI:1710558630
Name:DODGE, EMILY (DNP APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DODGE
Suffix:
Gender:F
Credentials:DNP APRN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GERRITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W5513 COLIN ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-8782
Mailing Address - Country:US
Mailing Address - Phone:920-450-9759
Mailing Address - Fax:
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:920-531-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225906163W00000X
WI548887163WM0705X
WI762335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical