Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CP002281 | SD |
NPI | 1003569104 |
---|---|
Provider Name | Dillon Matthew Hansen |
First Address | Sioux Falls, SD 57105-1005 |
Second Address | Sioux Falls, SD 57105-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |