Organization
COUNTY OF BLACK HAWK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAFISSA CISSE EGBUONYE (DIRECTOR)
(319) 291-2413
Entity
Organization
Contact information
Practice address
1407 INDEPENDENCE AVE FL 5, WATERLOO, IA 50703-4396
(319) 291-2413
(319) 291-2418
Mailing address
1407 INDEPENDENCE AVE FL 5, WATERLOO, IA 50703-4396
(319) 291-2413
(319) 291-2418
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0108381
—
IA
05
—
0235747
—
IA
05
—
0236612
—
IA
05
—
0241158
—
IA
01
—
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HCC STUDENT HEALTH
IA
Enumeration date
03/20/2007
Last updated
02/06/2019
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