Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 04-28994 | KS |
Y | 207VE0102X | Reproductive Endocrinologist | 8677 | SD |
NPI | 1093825408 |
---|---|
Provider Name | Tiffany A Von Wald |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-1503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 12/09/2013 |