Healthcare Provider Details

I. General information

NPI: 1083794903
Provider Name (Legal Business Name): CARMEN MARIA REDLIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN MARIA PRZYMUS CNP

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

IV. Provider business mailing address

401 9TH AVENUE NW
WATERTOWN SD
57201
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax:
Mailing address:
  • Phone: 605-882-5455
  • Fax: 605-882-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000234
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000234
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: