Basic Information
| Provider Information | |||||||||
| NPI: | 1669530671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURTH | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALTH | ||||||||
| OtherFirstName: | HEIDI | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4950 S. MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571082864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053309619 | ||||||||
| FaxNumber: | 6053309503 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 S MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571082591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226960 | ||||||||
| FaxNumber: | 6053226961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP000486 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 252490 | 01 | MIDLAND'S CHOICE | OTHER | 040122003 | 01 | PRIMEWEST | OTHER | 370624200 | 01 | DEPT. OF LABOR | OTHER | CP000486 | 01 | SD | CNP LICENSE | OTHER | 9243923 | 01 | SD | DAKOTACARE-DERM | OTHER | R030516 | 01 | SD | RN LICENSE | OTHER | 4992508 | 01 | SD | BLUE CROSS/SOUTH DAKOTA | OTHER | 57108B008 | 01 | WPS TRICARE | OTHER | 6I478FU | 01 | MN | BLUE CROSS-DERM | OTHER | 580082100 | 05 | MN | MEDICAID | 0575076 | 05 | IA | MEDICAID | 1669530671 | 01 | ARAZ/AMERICA'S PPO | OTHER | 6829172 | 05 | SD | MEDICAID | 6I478FU | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 6I478FU | 01 | MN | CC SYSTEMS/BLUE PLUS-DERM | OTHER | 6I478FU | 01 | MN | BLUE CROSS | OTHER |