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General NPI Number Information
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NPI Number | 1124789540
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Entity Type | Individual
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Provider Name | STEPHANIE LYN DARGATZ FNP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 301 FLYNN DR
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City | MILBANK
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State | SD
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Zip | 57252-1508
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Country | US
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Telephone | 605-432-4587
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Fax |
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Provider Business Mailing Address
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Address Line | 44083 US HIGHWAY 12
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City | WEBSTER
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State | SD
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Zip | 57274-5700
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Country | US
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Telephone | 605-265-0418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | CP002257
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License Number State | SD
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