Basic Information
| Provider Information | |||||||||
| NPI: | 1336589969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEZIEL | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN CHRISTIE MSS | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017375 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | SHENANDOAH MEDICAL CENTER | ||||||||
| Address2: | 300 PERSHING AVENUE | ||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122461230 | ||||||||
| FaxNumber: | 6057198826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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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 | 363L00000X | A148340 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.