MEDICARE: DWCNP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		SD

General Provider Information

NPI Number	:	1093077992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWCNP, LLC

Provider Business Mailing Address
First Line	:	5124 S WESTERN AVE
Second Line	:	SUITE 4
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5047
Country	:	US
Telephone Number	:	605-274-3898
Fax Number	:	605-274-3899

Provider Business Practice Location Address
First Line	:	5124 S WESTERN AVE
Second Line	:	SUITE 4
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5047
Country	:	US
Telephone Number	:	605-274-3898
Fax Number	:	605-274-3899

Authorized Official
Title or Position	:	CNP
Name	:	DENTON COMBS
Credential	:
Telephone Number	:	605-231-0403

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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