Healthcare Provider Details

I. General information

NPI: 1013118512
Provider Name (Legal Business Name): NICOLE MARIE POPPINGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS NICOLE MARIE FIRMAN

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501-3391
US

IV. Provider business mailing address

100 MAC LN
PIERRE SD
57501-3391
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5246
  • Fax: 605-945-5083
Mailing address:
  • Phone: 605-945-5246
  • Fax: 605-945-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8141
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: