Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 3349 | SD |
N | 208000000X | Pediatrician | 3349 | SD |
N | 2080P0205X | Pediatric Endocrinologist | 3349 | SD |
NPI | 1356394324 |
---|---|
Provider Name | Laura A Davis Keppen |
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 | 18/05/2006 |
Last Update Date | 13/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B90344 | (02) |