Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A068014 | IA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G068014 | IA |
NPI | 1033204045 |
---|---|
Provider Name | Jeanne M Kleinhesselink |
First Address | Sioux Center, IA 51250-2501 |
Second Address | Sioux Center, IA 51250-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 02/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S 45459 | (02) |