Provider Demographics
NPI:1174519763
Name:IRLMEIER, ANISSA J (PA-C)
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:J
Last Name:IRLMEIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1056
Mailing Address - Country:US
Mailing Address - Phone:712-563-4611
Mailing Address - Fax:712-563-2498
Practice Address - Street 1:515 PACIFIC AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1056
Practice Address - Country:US
Practice Address - Phone:712-563-4611
Practice Address - Fax:712-563-2498
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00968363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR90934Medicare UPIN
IA506121Medicare PIN