Healthcare Provider Details

I. General information

NPI: 1447709258
Provider Name (Legal Business Name): LORINDA ANN DEKKERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W 95TH ST
SIOUX FALLS SD
57108-6399
US

IV. Provider business mailing address

2401 W 95TH ST
SIOUX FALLS SD
57108-6399
US

V. Phone/Fax

Practice location:
  • Phone: 605-743-2567
  • Fax: 605-271-0410
Mailing address:
  • Phone: 605-743-2567
  • Fax: 605-271-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR042565
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: