Jacob Warren Kooistra Devries
Jacob Warren Kooistra Devries is a Student in an Organized Health Care Education/Training Program in Bloomington, Indiana. Registered with an NPI since 2022.
- In the registry since
- 2022
Practice location Address checks out
701 E 17th StBloomington, IN 47408-1578
Phone: (812) 856-4465
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Specialties & licences
| Student in an Organized Health Care Education/Training Program (primary) | Taxonomy 390200000X |
|---|
Record details
| NPI number | 1811658131 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | January 8, 2022 |
| Last updated in NPPES | January 8, 2022 |
| Certification date | January 8, 2022 |
| Mailing address | 4425 Hickory Grove Blvd, Greenwood, IN 46143-7445 |
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