Healthcare Provider Details

I. General information

NPI: 1306379896
Provider Name (Legal Business Name): JOYCE A SELLAND LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE A GERAETS LPN

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BIA ROUTE 4
FT. THOMPSON SD
57339
US

IV. Provider business mailing address

PO BOX 200 1323 BIA ROUTE 4
FT. THOMPSON SD
57339
US

V. Phone/Fax

Practice location:
  • Phone: 605-245-1618
  • Fax: 605-245-2277
Mailing address:
  • Phone: 605-245-1618
  • Fax: 605-245-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberSD-LPN P004198
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: