Healthcare Provider Details

I. General information

NPI: 1558723940
Provider Name (Legal Business Name): NNAEMEKA EGBUNA ONYEAKUSI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

IV. Provider business mailing address

905 FRANKLIN STREET
WATERLOO IA
50703
US

V. Phone/Fax

Practice location:
  • Phone: 319-874-3000
  • Fax:
Mailing address:
  • Phone: 979-200-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-48107
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: