Basic Information
Provider Information
NPI: 1245871466
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGEE
FirstName: NOELLE
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4600 S EQUITY DR
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571067510
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1600 W 22ND ST
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571051521
CountryCode: US
TelephoneNumber: 6053121000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/30/2019
LastUpdateDate: 09/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCP001649SDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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