Healthcare Provider Details

I. General information

NPI: 1093077992
Provider Name (Legal Business Name): DWCNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 S WESTERN AVE SUITE 4
SIOUX FALLS SD
57108-5047
US

IV. Provider business mailing address

5124 S WESTERN AVE SUITE 4
SIOUX FALLS SD
57108-5047
US

V. Phone/Fax

Practice location:
  • Phone: 605-274-3898
  • Fax: 605-274-3899
Mailing address:
  • Phone: 605-274-3898
  • Fax: 605-274-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateSD

VIII. Authorized Official

Name: DENTON COMBS
Title or Position: CNP
Credential:
Phone: 605-231-0403