MEDICARE: ALEESHA MARIE DEKNIKKER CNP

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	207Q00000X	Family Medicine Physician	CP001751	SD
2	363LF0000X	Family Nurse Practitioner	CP001751	SD

General Provider Information

NPI Number	:	1720608417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEESHA MARIE DEKNIKKER CNP

Provider Business Mailing Address
First Line	:	1112 S LAKE AVE
Second Line	:	STE 201
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105
Country	:	US
Telephone Number	:	605-333-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S HILL ST
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058-8760
Country	:	US
Telephone Number	:	605-425-2855
Fax Number	:	605-425-2149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	11/08/2022

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