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Individual
DONALD DEE TIETSEMA III
Active
Individual
DONALD DEE TIETSEMA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1627153
CO
163W00000X
Registered Nurse
4704274155
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
991309
CO
Other
Enumeration date
09/22/2014
Last updated
02/11/2021
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