Healthcare Provider Details

I. General information

NPI: 1508570862
Provider Name (Legal Business Name): LISA M CHASE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 W 69TH ST
SIOUX FALLS SD
57108-8148
US

IV. Provider business mailing address

4520 W 69TH ST
SIOUX FALLS SD
57108-8148
US

V. Phone/Fax

Practice location:
  • Phone: 605-977-5000
  • Fax: 605-977-5377
Mailing address:
  • Phone: 605-977-5000
  • Fax: 605-977-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP002624
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: