Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 000114 | SD |
NPI | 1124158316 |
---|---|
Provider Name | Dianne Bliss |
First Address | Sioux Falls, SD 57105-0401 |
Second Address | Sioux Falls, SD 57105-0401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 21/10/2011 |