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General NPI Number Information
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NPI Number | 1841284262
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Entity Type | Individual
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Provider Name | LUANN EIDSNESS MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 1205 S GRANGE AVE STE 510
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City | SIOUX FALLS
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State | SD
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Zip | 57105-0407
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Country | US
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Telephone | 605-328-0020
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Fax | 605-328-0021
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone | 605-312-7607
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Fax | 605-312-7611
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3342
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 3342
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License Number State | SD
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