Healthcare Provider Details

I. General information

NPI: 1588824403
Provider Name (Legal Business Name): NICOLE DAWN VAN GINKEL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 ST ANDREWS WAY
SIOUX CENTER IA
51250
US

IV. Provider business mailing address

PO BOX 23
SIOUX CENTER IA
51250-0023
US

V. Phone/Fax

Practice location:
  • Phone: 712-470-0303
  • Fax:
Mailing address:
  • Phone: 712-470-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007046
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: