Basic Information
| Provider Information | |||||||||
| NPI: | 1669408308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLERT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5045 | ||||||||
| Address2: | ATTN: P.F.S. - PROV ENROLLMENT | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226428 | ||||||||
| FaxNumber: | 6053226499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222754 | ||||||||
| FaxNumber: | 6053353505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CR000564 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 5753982 | 05 | SD | MEDICAID | 914S2EN | 01 | MN | BLUE CROSS MN | OTHER | 4995050 | 01 | SD | BLUE CROSS SD | OTHER | 584409 | 05 | IA | MEDICAID | 176642200 | 05 | MN | MEDICAID |