Provider Demographics
NPI:1811783103
Name:KADIATA, TOUTOU
Entity type:Individual
Prefix:
First Name:TOUTOU
Middle Name:
Last Name:KADIATA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 N RIVER BLVD NE
Mailing Address - Street 2:4515 N RIVER BLVD NE
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411
Mailing Address - Country:US
Mailing Address - Phone:319-509-5962
Mailing Address - Fax:
Practice Address - Street 1:4515 N RIVER BLVD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411
Practice Address - Country:US
Practice Address - Phone:319-509-5962
Practice Address - Fax:319-509-5962
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider