Provider Demographics
NPI:1760016786
Name:MINDY JO ROBERTS INC
Entity Type:Organization
Organization Name:MINDY JO ROBERTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:563-590-6597
Mailing Address - Street 1:15740 N CASCADE RD
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-7027
Mailing Address - Country:US
Mailing Address - Phone:563-590-6597
Mailing Address - Fax:
Practice Address - Street 1:2600 DODGE ST STE D4
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7161
Practice Address - Country:US
Practice Address - Phone:563-590-6597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty