Provider Demographics
NPI:1548733652
Name:OZBOURNE NIGRO, CANZADIE AUTUMN
Entity Type:Individual
Prefix:
First Name:CANZADIE
Middle Name:AUTUMN
Last Name:OZBOURNE NIGRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DICKENS ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-2034
Mailing Address - Country:US
Mailing Address - Phone:319-429-3241
Mailing Address - Fax:
Practice Address - Street 1:302 DICKENS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-2034
Practice Address - Country:US
Practice Address - Phone:319-883-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health