Healthcare Provider Details

I. General information

NPI: 1316851447
Provider Name (Legal Business Name): IMMACULATA MARIS NKIRUKA ECHIBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 157TH ST
URBANDALE IA
50323-2285
US

IV. Provider business mailing address

2803 157TH ST
URBANDALE IA
50323-2285
US

V. Phone/Fax

Practice location:
  • Phone: 815-616-0980
  • Fax:
Mailing address:
  • Phone: 815-616-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number193264
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: