Basic Information
| Provider Information | |||||||||
| NPI: | 1447978028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERTEL | ||||||||
| FirstName: | JAKOB | ||||||||
| MiddleName: | GABRIEL | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 SAINT JEROME ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570322241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052546459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6100 S LOUISE AVE # 2100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571086029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2022 | ||||||||
| LastUpdateDate: | 10/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP002487 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.