Healthcare Provider Details

I. General information

NPI: 1043123383
Provider Name (Legal Business Name): NICHOLAS JAMES WURTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 BRENDELWOOD DR NW
CEDAR RAPIDS IA
52405-1584
US

IV. Provider business mailing address

1625 BRENDELWOOD DR NW
CEDAR RAPIDS IA
52405-1584
US

V. Phone/Fax

Practice location:
  • Phone: 319-297-8607
  • Fax: 319-364-5033
Mailing address:
  • Phone: 319-297-8607
  • Fax: 319-364-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172862
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: