Healthcare Provider Details

I. General information

NPI: 1164811618
Provider Name (Legal Business Name): TODD W PERSSON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 04/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S GRANGE AVE STE 201
SIOUX FALLS SD
57105-0414
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8188
  • Fax:
Mailing address:
  • Phone: 605-328-8188
  • Fax: 605-328-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000923
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: