Provider Demographics
NPI:1285518209
Name:MATHIASEN, JEFFREY BERNARD
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BERNARD
Last Name:MATHIASEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BUTTERNUT CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1208
Mailing Address - Country:US
Mailing Address - Phone:712-314-3834
Mailing Address - Fax:
Practice Address - Street 1:10 BUTTERNUT CIR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1208
Practice Address - Country:US
Practice Address - Phone:712-314-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider