Jens Paul Nuesken, LPTA
Individual provider Active NPI Specialist · Delavan, IL
NPI 1770899254 · NPPES record last updated Aug 23, 2010
Key facts
- NPI
- 1770899254
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 160005451 (IL)
- Practice address
- 505 W 4TH St
Delavan, IL 61734-9688 - Phone
- (309) 241-7814
- NPI assigned
- Aug 23, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160005451 | IL | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 160005451 | IL | Yes |
Addresses
Primary practice location
505 W 4TH St
Delavan, IL 61734-9688
Mailing address
PO Box 684
Delavan, IL 61734-0684
Phone (309) 241-7814
Other providers in Delavan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.