Healthcare Provider Details

I. General information

NPI: 1568998276
Provider Name (Legal Business Name): HANNAH DJOUMESSI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E DONALD ST
WATERLOO IA
50703-1500
US

IV. Provider business mailing address

716 2ND AVE NE
WAVERLY IA
50677-2720
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-1911
  • Fax: 319-287-5832
Mailing address:
  • Phone: 319-483-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA127389
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: