Healthcare Provider Details

I. General information

NPI: 1871001495
Provider Name (Legal Business Name): ANDREA NEIL NELSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 22ND ST
SIOUX FALLS SD
57105-7702
US

IV. Provider business mailing address

7520 W STONEY CREEK ST
SIOUX FALLS SD
57106-7769
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-4095
  • Fax:
Mailing address:
  • Phone: 605-261-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000983
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: