=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760292411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER KNEIFL BSN, RN, CWON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 W 22ND ST
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57105-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-336-3230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27449 477TH AVE
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57032-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number | R041415
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------