Healthcare Provider Details

I. General information

NPI: 1235185919
Provider Name (Legal Business Name): NANCY L CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 E 26TH ST
SIOUX FALLS SD
57103-4136
US

IV. Provider business mailing address

4405 E 26TH ST
SIOUX FALLS SD
57103-4136
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-2883
  • Fax: 605-332-9001
Mailing address:
  • Phone: 605-332-2883
  • Fax: 605-332-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1446
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: