Basic Information
| Provider Information | |||||||||
| NPI: | 1336115609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEADRICK | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CNP | ||||||||
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| 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: | 911 E. 20TH ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223455 | ||||||||
| FaxNumber: | 6053223456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 0271 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 230278 | 01 | SD | MIDLANDS CHOICE | OTHER | 28563 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 67B26HE | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 140309 | 01 | MN | UCARE | OTHER | 57105E002 | 01 | SD | WPS TRICARE | OTHER | AH1451026885 | 01 | SD | PREFERRED ONE | OTHER | 0007481 | 01 | SD | BLUE CROSS | OTHER | HP37108 | 01 | SD | HEALTHPARTNERS | OTHER | 6826982 | 05 | SD | MEDICAID | 0585661 | 05 | IA | MEDICAID | 1194219 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 579152900 | 05 | MN | MEDICAID | 0701587 | 01 | SD | MEDICA | OTHER | 10025120100 | 05 | NE | MEDICAID | 67B26HE | 01 | MN | BLUE CROSS | OTHER | 500016956 | 01 | SD | RR MEDICARE | OTHER | 9240518 | 01 | SD | DAKOTACARE | OTHER |