Healthcare Provider Details

I. General information

NPI: 1760308290
Provider Name (Legal Business Name): NICHOLAS LEE TIESZEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE
SIOUX FALLS SD
57105-1005
US

IV. Provider business mailing address

1325 S CLIFF AVE
SIOUX FALLS SD
57105-1005
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8000
  • Fax:
Mailing address:
  • Phone: 605-322-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License NumberR060432
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: