Provider Demographics
NPI:1336426949
Name:TYSON, EMILY LOUISE (CD(DONA), HBCE)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LOUISE
Last Name:TYSON
Suffix:
Gender:F
Credentials:CD(DONA), HBCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2761
Mailing Address - Country:US
Mailing Address - Phone:319-750-9021
Mailing Address - Fax:
Practice Address - Street 1:1822 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2761
Practice Address - Country:US
Practice Address - Phone:319-750-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8662374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula