Provider Demographics
NPI:1184360083
Name:WIERSEMA, THOMAS (REEGT, CNIM, CLTM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WIERSEMA
Suffix:
Gender:M
Credentials:REEGT, CNIM, CLTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRANT AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 S WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1928
Practice Address - Country:US
Practice Address - Phone:319-899-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic