Healthcare Provider Details

I. General information

NPI: 1962939231
Provider Name (Legal Business Name): THERESA MICHELLE NEWCOMB APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S ELLIS RD
SIOUX FALLS SD
57106-7067
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-2883
  • Fax: 605-323-8283
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112207
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001728
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: