Healthcare Provider Details

I. General information

NPI: 1811358922
Provider Name (Legal Business Name): MICHAL PUTZKE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 02/15/2020
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

8009 W CHESAPEAKE LN
SIOUX FALLS SD
57106-5194
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-7260
  • Fax:
Mailing address:
  • Phone: 605-212-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001048
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP001048
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: