Healthcare Provider Details

I. General information

NPI: 1275408866
Provider Name (Legal Business Name): ALYSSA L PLOEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28323 BARTLETT AVE
CANTON SD
57013-5851
US

IV. Provider business mailing address

28323 BARTLETT AVE
CANTON SD
57013-5851
US

V. Phone/Fax

Practice location:
  • Phone: 605-321-7630
  • Fax:
Mailing address:
  • Phone: 605-321-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberR060064
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: