Healthcare Provider Details

I. General information

NPI: 1174218366
Provider Name (Legal Business Name): AMY R SKOGLUND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S BROADBAND LN
SIOUX FALLS SD
57108-2222
US

IV. Provider business mailing address

5300 S BROADBAND LN
SIOUX FALLS SD
57108-2222
US

V. Phone/Fax

Practice location:
  • Phone: 605-504-3387
  • Fax:
Mailing address:
  • Phone: 605-504-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberR046254
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR046254
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: