MEDICARE: JAMIE PAUL SLETTEDAHL DNP, FNP-C, DBSM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CP001230	SD

General Provider Information

NPI Number	:	1164943098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE PAUL SLETTEDAHL DNP, FNP-C, DBSM

Provider Business Mailing Address
First Line	:	2640 JACKSON BLVD STE 1
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-697-5337
Fax Number	:	605-340-6315

Provider Business Practice Location Address
First Line	:	2640 JACKSON BLVD STE 1
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-697-5337
Fax Number	:	605-340-6315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	10/09/2025

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