Healthcare Provider Details

I. General information

NPI: 1013377944
Provider Name (Legal Business Name): LINDSEY NEDVED NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 3RD ST SW
WAGNER SD
57380-9675
US

IV. Provider business mailing address

513 3RD ST SW
WAGNER SD
57380-9675
US

V. Phone/Fax

Practice location:
  • Phone: 605-384-3611
  • Fax:
Mailing address:
  • Phone: 605-384-3611
  • Fax: 605-384-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001055
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: