Healthcare Provider Details

I. General information

NPI: 1972999704
Provider Name (Legal Business Name): JESLYN MARIE KLEINSCHMIT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

200 S LA SALLE AVE
SIOUX FALLS SD
57110-1224
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-1000
  • Fax:
Mailing address:
  • Phone: 605-376-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR038359
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000883
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: