Healthcare Provider Details

I. General information

NPI: 1457723660
Provider Name (Legal Business Name): GRANT JASPERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE
SIOUX FALLS SD
57105-1007
US

IV. Provider business mailing address

PO BOX 5045
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7905
  • Fax: 605-322-8414
Mailing address:
  • Phone: 605-322-7905
  • Fax: 605-322-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001000
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: