Basic Information
| Provider Information | |||||||||
| NPI: | 1265760102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDUGLE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NICHOLS | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 911 E. 20TH ST. | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 E. 20TH ST. | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R032447 | SD | N | Nursing Service Providers | Registered Nurse | 363LF0000X | CP000582 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SC0200X | CS004119 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Critical Care Medicine |
No ID Information.