Provider Demographics
NPI:1780096826
Name:NIEUSMA, HOLLY (DO)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NIEUSMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:JO
Other - Last Name:CONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4378 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1634
Mailing Address - Country:US
Mailing Address - Phone:517-694-1466
Mailing Address - Fax:517-694-3530
Practice Address - Street 1:4378 HOLT RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1634
Practice Address - Country:US
Practice Address - Phone:517-694-1466
Practice Address - Fax:517-694-3530
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021021390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program