Healthcare Provider Details

I. General information

NPI: 1376971770
Provider Name (Legal Business Name): DANNICA CALLIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH ST SE
LAKE PRESTON SD
57249-2116
US

IV. Provider business mailing address

709 4TH ST SE
LAKE PRESTON SD
57249-2116
US

V. Phone/Fax

Practice location:
  • Phone: 605-847-4484
  • Fax: 605-847-4732
Mailing address:
  • Phone: 605-847-4484
  • Fax: 605-847-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000817
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: