Provider Demographics
NPI:1447680848
Name:ROBERTS, MINDY JO (ARNP)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:JO
Last Name:ROBERTS
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 1:15740 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:563-587-8368
Practice Address - Fax:949-577-4968
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH095579363LA2200X
IAJ095579363LG0600X
IAG095579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology