Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CP001103 | SD |
NPI | 1003269176 |
---|---|
Provider Name | Paul Stamp |
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 | 13/07/2016 |
Last Update Date | 13/07/2016 |