Basic Information
| Provider Information | |||||||||
| NPI: | 1427097260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VENHUIZEN MATT | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VENHUIZEN | ||||||||
| OtherFirstName: | TONYA | ||||||||
| OtherMiddleName: | R. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S. CLIFF AVE | ||||||||
| Address2: | STE 601 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226930 | ||||||||
| FaxNumber: | 6053226931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP000141 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1427097260 | 01 | SD | ARAZ/AMERICA'S PPO | OTHER | 46L65VE | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 4992678 | 01 | SD | BLUE CROSS | OTHER | 407141053077 | 01 | PREFERRED ONE | OTHER | 9237741 | 01 | SD | DAKOTACARE | OTHER | 6825863 | 05 | SD | MEDICAID | HP94300 | 01 | HEALTHPARTNERS | OTHER | 2920926 | 05 | IA | MEDICAID | 46L65VE | 01 | MN | BLUE CROSS | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 255119 | 01 | MIDLAND'S CHOICE | OTHER | 40252 | 01 | SD | MEDICARE GROUP # | OTHER | 57105W012 | 01 | SD | WPS TRICARE | OTHER | 682443000 | 05 | MN | MEDICAID | 92411422905 | 01 | MN | PRIMEWEST | OTHER | 1427097260 | 01 | SD | MEDICA | OTHER |