Basic Information
| Provider Information | |||||||||
| NPI: | 1891182911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JESPERSEN NIZAMIC | ||||||||
| FirstName: | TIANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2003 KOOTENAI HEALTH WAY | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838146051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086256100 | ||||||||
| FaxNumber: | 2086256101 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W IRONWOOD DR STE 375 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086256100 | ||||||||
| FaxNumber: | 2086256101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | M-15908 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.