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Individual

MR. DALLAS BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
1011 PENNSYLVANIA AVE, OTTUMWA, IA 52501-2129
(641) 682-7511
Mailing address
PO BOX 1179, OTTUMWA, IA 52501-7179
(319) 800-9600

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
H165013
IA

Other

Enumeration date
08/04/2021
Last updated
01/21/2022
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