Healthcare Provider Details

I. General information

NPI: 1629950134
Provider Name (Legal Business Name): CARISSA GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S HIGHLINE PL
SIOUX FALLS SD
57110-3061
US

IV. Provider business mailing address

7809 W 48TH ST
SIOUX FALLS SD
57106-7222
US

V. Phone/Fax

Practice location:
  • Phone: 605-401-2477
  • Fax:
Mailing address:
  • Phone: 605-413-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003721
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: