Basic Information
| Provider Information | |||||||||
| NPI: | 1720608417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEKNIKKER | ||||||||
| FirstName: | ALEESHA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 S LAKE AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053331000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 740 S HILL ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570588760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054252855 | ||||||||
| FaxNumber: | 6054252149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CP001751 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | CP001751 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.