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General NPI Number Information
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NPI Number | 1730203407
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Entity Type | Organization
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Legal Business Name | COUNTY OF BLACK HAWK
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1407 INDEPENDENCE AVE 5TH FLOOR
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City | WATERLOO
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State | IA
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Zip | 50703-4396
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Country | US
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Telephone | 319-291-2413
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Fax | 319-291-2418
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Provider Business Mailing Address
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Address Line | 1407 INDEPENDENCE AVE 5TH FLOOR
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City | WATERLOO
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State | IA
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Zip | 50703-4396
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Country | US
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Telephone | 319-291-2413
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Fax | 319-291-2418
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. NAFISSA CISSE EGBUONYE
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Credential |
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Telephone | 319-291-2413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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