Healthcare Provider Details

I. General information

NPI: 1124789540
Provider Name (Legal Business Name): STEPHANIE LYN DARGATZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N MAIN ST
WAUBAY SD
57273-1901
US

IV. Provider business mailing address

80 N MAIN ST
WAUBAY SD
57273-1901
US

V. Phone/Fax

Practice location:
  • Phone: 605-947-3422
  • Fax: 605-947-3423
Mailing address:
  • Phone: 605-947-3422
  • Fax: 605-947-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberCP002257
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: