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General NPI Number Information
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NPI Number | 1790244341
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Entity Type | Organization
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Legal Business Name | AMERICAN ADVANCED PRACTICE NETWORK, P.C.
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1056 29TH ST SE
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City | WATERTOWN
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State | SD
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Zip | 57201-9120
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Country | US
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Telephone | 605-753-0960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 269083 LOCKBOX #2035
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-9083
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | ALLEN EWALT
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Credential |
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Telephone | 646-970-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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