Basic Information
| Provider Information | |||||||||
| NPI: | 1154552412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTICE | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055045400 | ||||||||
| FaxNumber: | 6055045150 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055045400 | ||||||||
| FaxNumber: | 6055045150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2009 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP000560 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 6832470 | 05 | SD | MEDICAID |