Basic Information
| Provider Information | |||||||||
| NPI: | 1346877560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERPELDING | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 605 BLUFF ST APT 605 | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520014672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155187328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3500 DODGE ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520035208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635832007 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 088757 | IA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 088575 | 01 | IA | HIS | OTHER |