Healthcare Provider Details

I. General information

NPI: 1568711786
Provider Name (Legal Business Name): NICOLE MARIE ROSENKRANS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 FUTURES DR
SOUTH SIOUX CITY NE
68776-3917
US

IV. Provider business mailing address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

V. Phone/Fax

Practice location:
  • Phone: 402-412-7242
  • Fax: 712-252-5920
Mailing address:
  • Phone: 712-252-2477
  • Fax: 712-252-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000855
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA106233
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114106
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: