Provider Demographics
NPI:1861901621
Name:MCINTOSH, EMILY ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:MCINTOSH
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:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:IA
Mailing Address - Zip Code:50069-0036
Mailing Address - Country:US
Mailing Address - Phone:515-205-0496
Mailing Address - Fax:
Practice Address - Street 1:425 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:IA
Practice Address - Zip Code:50069
Practice Address - Country:US
Practice Address - Phone:515-205-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA118151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner