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General NPI Number Information
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NPI Number | 1366346280
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Entity Type | Individual
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Provider Name | JOHN GUNDERSON RN
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Gender | Male
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 1440 N MAIN ST
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City | SPEARFISH
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State | SD
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Zip | 57783-1505
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Country | US
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Telephone | 605-644-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 18 LOURIE LN
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City | SPEARFISH
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State | SD
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Zip | 57783-1144
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Country | US
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Telephone | 605-641-9851
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | R034405
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License Number State | SD
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