=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467017202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELINA MARIE ROHLFS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2019
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 S STATE ST STE 113
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57401-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-594-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 S STATE ST STE 113
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57401-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-594-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 68781
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 29888
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 13639
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------