Healthcare Provider Details

I. General information

NPI: 1740108141
Provider Name (Legal Business Name): NITHULA MARIAM JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NEWTON RD
IOWA CITY IA
52242-8004
US

IV. Provider business mailing address

322 DENTAL SCIENCE S BLDG S
IOWA CITY IA
52242-1034
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-7440
  • Fax: 319-335-7451
Mailing address:
  • Phone: 319-335-7440
  • Fax: 319-335-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES-30744
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: