Provider Demographics
NPI:1891017638
Name:DYKHUIS, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:DYKHUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1327
Mailing Address - Country:US
Mailing Address - Phone:612-481-0830
Mailing Address - Fax:
Practice Address - Street 1:3304 VERNON ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1327
Practice Address - Country:US
Practice Address - Phone:612-481-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula