Healthcare Provider Details

I. General information

NPI: 1043120074
Provider Name (Legal Business Name): SOLANGE MIMI KOBWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4893 1ST AVE SW APT 3A
CEDAR RAPIDS IA
52405-4258
US

IV. Provider business mailing address

4893 1ST AVE SW APT 3A
CEDAR RAPIDS IA
52405-4258
US

V. Phone/Fax

Practice location:
  • Phone: 319-573-6759
  • Fax:
Mailing address:
  • Phone: 319-573-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCHLT-4005-152057
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: