Healthcare Provider Details

I. General information

NPI: 1407337819
Provider Name (Legal Business Name): ERIN STANSBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MILLER

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

4112 S OUTFIELD AVE
SIOUX FALLS SD
57110-4114
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8700
  • Fax: 605-328-8701
Mailing address:
  • Phone: 605-929-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001421
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: