Healthcare Provider Details

I. General information

NPI: 1427659721
Provider Name (Legal Business Name): TAYLOR NICOLE VAKSDAL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR NICOLE NELSON

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 W 22ND ST STE 101
SIOUX FALLS SD
57105-1514
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-3840
  • Fax: 605-328-3841
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP001880
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: