Healthcare Provider Details

I. General information

NPI: 1508204272
Provider Name (Legal Business Name): CHARLOTTE DOHN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 3RD ST SE SUITE 201
HURON SD
57350-2063
US

IV. Provider business mailing address

6415 W 55TH ST
SIOUX FALLS SD
57106-1962
US

V. Phone/Fax

Practice location:
  • Phone: 605-353-0858
  • Fax: 605-610-4063
Mailing address:
  • Phone: 605-310-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000774
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: