Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MT11224 | SD |
NPI | 1215354386 |
---|---|
Provider Name | Ms. Nicole Rose Dahms |
First Address | Sioux Falls, SD 57103-4089 |
Second Address | Sioux Falls, SD 57103-4089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 06/04/2017 |