Basic Information
| Provider Information | |||||||||
| NPI: | 1275502726 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WETJEN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7147 VISTA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502669313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759925 | ||||||||
| FaxNumber: | 5158759923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 PLEASANT ST STE 608 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152415760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD-45106 | IA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 43826 | MN | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.