Healthcare Provider Details

I. General information

NPI: 1760328900
Provider Name (Legal Business Name): CHRISTINA ANN MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

V. Phone/Fax

Practice location:
  • Phone: 605-347-2511
  • Fax:
Mailing address:
  • Phone: 605-347-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN207564
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP012806
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: