Basic Information
Provider Information
NPI: 1174846612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHELHAAS
FirstName: TERESA
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 S. MINNESOTA AVE
Address2: STE 100
City: SIOUX FALLS
State: SD
PostalCode: 571053762
CountryCode: US
TelephoneNumber: 6053227510
FaxNumber: 6053226475
Practice Location
Address1: 1301 S. CLIFF AVE
Address2: STE 401
City: SIOUX FALLS
State: SD
PostalCode: 571051023
CountryCode: US
TelephoneNumber: 6053227300
FaxNumber: 6053227301
Other Information
ProviderEnumerationDate: 03/11/2010
LastUpdateDate: 12/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCP000587SDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
683311005SD MEDICAID


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