Healthcare Provider Details

I. General information

NPI: 1942026802
Provider Name (Legal Business Name): JENNIFER CHRISTIN CANTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE
SIOUX FALLS SD
57105-1007
US

IV. Provider business mailing address

4901 S ASH GROVE AVE
SIOUX FALLS SD
57108-4710
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-4286
  • Fax:
Mailing address:
  • Phone: 605-370-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR035863
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: