Healthcare Provider Details

I. General information

NPI: 1821062167
Provider Name (Legal Business Name): TIMOTHY S MASSELINK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/25/2007
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

7023 S HIGH CROSS TRL
SIOUX FALLS SD
57108-3332
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-1000
  • Fax:
Mailing address:
  • Phone: 605-336-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000632
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: