Healthcare Provider Details

I. General information

NPI: 1265406698
Provider Name (Legal Business Name): SHAUNA L RICH JACOBSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUNA JACOBSON

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-1000
  • Fax:
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-312-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD099344
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0581
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: