Healthcare Provider Details

I. General information

NPI: 1194603373
Provider Name (Legal Business Name): HANNA EIDE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNA SLAGLE

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 4TH ST NW
WATERTOWN SD
57201-1558
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8471
  • Fax:
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003773
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: