Individual
DONALD DEE TIETSEMA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
8745 COUNTY ROAD 9 S, ALAMOSA, CO 81101-9610
(719) 589-3671
(719) 587-6824
Mailing address
8745 COUNTY ROAD 9 S, ALAMOSA, CO 81101-9610
(719) 589-3671
(719) 587-6824
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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