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General NPI Number Information
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NPI Number | 1316150758
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Entity Type | Organization
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Legal Business Name | MERCY WEIGHT LOSS CENTER AT DAKOTA DUNES
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 705 SIOUX POINT RD SUITE 100
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5091
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Country | US
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Telephone | 605-217-5566
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Fax | 605-217-5513
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Provider Business Mailing Address
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Address Line | 705 SIOUX POINT RD SUITE 100
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5091
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Country | US
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Telephone | 605-217-5566
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Fax | 605-217-5513
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Authorized Official
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Title or Position | BARIATRIC NURSE COORDINATOR
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Name | MS. JENNIFER L BLACK
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Credential | R.N.
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Telephone | 605-217-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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