Provider Demographics
NPI:1215341250
Name:NIEUWENHUIS, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:NIEUWENHUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN CIR SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1836
Mailing Address - Country:US
Mailing Address - Phone:712-737-5225
Mailing Address - Fax:
Practice Address - Street 1:2501 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3725
Practice Address - Country:US
Practice Address - Phone:712-294-5000
Practice Address - Fax:712-294-5091
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine