Basic Information
| Provider Information | |||||||||
| NPI: | 1235482118 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWEET DREAMS ANESTHESIA PROF, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5126 | ||||||||
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| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053351952 | ||||||||
| FaxNumber: | 6053739971 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | YANKTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570783306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056657841 | ||||||||
| FaxNumber: | 6053739971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2012 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | KLINKHAMMER | ||||||||
| AuthorizedOfficialFirstName: | ALEXIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6052013495 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CR000719 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.