Basic Information
| Provider Information | |||||||||
| NPI: | 1780096826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEUSMA | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CONE | ||||||||
| OtherFirstName: | HOLLY | ||||||||
| OtherMiddleName: | JO | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4378 HOLT RD | ||||||||
| Address2: | |||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176941466 | ||||||||
| FaxNumber: | 5176943530 | ||||||||
| Practice Location | |||||||||
| Address1: | 4378 HOLT RD | ||||||||
| Address2: | |||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176941466 | ||||||||
| FaxNumber: | 5176943530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 5101021021 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 5101021021 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.