Healthcare Provider Details

I. General information

NPI: 1790244341
Provider Name (Legal Business Name): AMERICAN ADVANCED PRACTICE NETWORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 29TH ST SE
WATERTOWN SD
57201-9120
US

IV. Provider business mailing address

PO BOX 269083 LOCKBOX #2035
OKLAHOMA CITY OK
73126-9083
US

V. Phone/Fax

Practice location:
  • Phone: 605-753-0960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALLEN EWALT
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 646-970-3538