Basic Information
| Provider Information | |||||||||
| NPI: | 1831553049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN MAANEN | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723394 | ||||||||
| FaxNumber: | 6416723336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723394 | ||||||||
| FaxNumber: | 6416723336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2016 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | MD-48817 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.