Healthcare Provider Details

I. General information

NPI: 1194637397
Provider Name (Legal Business Name): MARA CHRISTINE FIEGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E 8TH ST
FREEMAN SD
57029-2086
US

IV. Provider business mailing address

PO BOX 617
FREEMAN SD
57029-0617
US

V. Phone/Fax

Practice location:
  • Phone: 605-925-4000
  • Fax:
Mailing address:
  • Phone: 605-412-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: