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Nursing Service Providers Licensed Practical Nurse

Provider NPI: 1356895163

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
3408 E MADISON ST  SIOUX FALLS, SD 57103-6202 US
Tel: 605-321-7305  Fax: --

Business Mailing Address:
3408 E MADISON ST  SIOUX FALLS, SD 57103-6202 US
Tel: 605-321-7305  Fax: --

NPI Information:
NPI: 1356895163
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y164W00000XNursing Service Providers
Licensed Practical Nurse
N171WH0202XOther Service Providers
N172A00000XOther Service Providers
N372500000XNursing Service Related Providers
Chore Provider
N372600000XNursing Service Related Providers
Adult Companion
N373H00000XNursing Service Related Providers
Day Training/Habilitation Specialist
N374U00000XNursing Service Related Providers
Home Health Aide
N376J00000XNursing Service Related Providers
N171R00000XOther Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 164W00000X





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