Healthcare Provider Details

I. General information

NPI: 1861415127
Provider Name (Legal Business Name): PAMELA G ELSHERE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E FIGZEL CT SUITE 100
TEA SD
57064-2276
US

IV. Provider business mailing address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0900
US

V. Phone/Fax

Practice location:
  • Phone: 605-368-9899
  • Fax: 605-368-5089
Mailing address:
  • Phone: 605-504-5195
  • Fax: 605-504-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0567
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: