Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | CP001109 | SD |
NPI | 1285187252 |
---|---|
Provider Name | Deann K Matthiesen |
First Address | Sioux Falls, SD 57105-1007 |
Second Address | Sioux Falls, SD 57105-1007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2016 |
Last Update Date | 26/07/2016 |