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General NPI Number Information
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NPI Number | 1942572086
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Entity Type | Individual
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Provider Name | TRICHELLE GRACE PETERMANN CNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 911 E 20TH ST STE 400
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1042
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Country | US
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Telephone | 605-332-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 5527 STEWART ST
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City | MILTON
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State | FL
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Zip | 32570-4303
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Country | US
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Telephone | 605-322-7510
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Fax | 605-322-6475
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | CP000680
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License Number State | SD
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