Individual
MR. MARK NIENHUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
#10 PUEBLO PINTADO SCHOOL, CUBA, NM 87013
(505) 786-5291
(505) 786-6440
Mailing address
PO BOX 358, CROWNPOINT, NM 87313-0358
(505) 786-5291
(505) 786-6440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50001806
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97702242
—
NM
Enumeration date
07/03/2006
Last updated
07/08/2007
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