Healthcare Provider Details

I. General information

NPI: 1275229254
Provider Name (Legal Business Name): JACLYN NIENHUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S 8TH AVE STE 103
STERLING CO
80751-4560
US

IV. Provider business mailing address

1405 S 8TH AVE STE 103
STERLING CO
80751-4560
US

V. Phone/Fax

Practice location:
  • Phone: 970-466-0039
  • Fax: 970-522-4615
Mailing address:
  • Phone: 970-740-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0078140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: