Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CP001879 | SD |
N | 363LP0200X | Nurse Practitioner - Pediatrics | CP001879 | SD |
NPI | 1033711544 |
---|---|
Provider Name | Janelle Vande Griend |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-1521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2020 |
Last Update Date | 05/02/2021 |