Healthcare Provider Details

I. General information

NPI: 1457418857
Provider Name (Legal Business Name): AMIEL NARCELLE REDFISH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W BIRCH
ARLINGTON SD
57212-0291
US

IV. Provider business mailing address

PO BOX 291 104 W. BIRCH
ARLINGTON SD
57212-0291
US

V. Phone/Fax

Practice location:
  • Phone: 605-983-3283
  • Fax: 605-983-5112
Mailing address:
  • Phone: 605-983-3283
  • Fax: 605-983-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberSD0173
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: