Basic Information
| Provider Information | |||||||||
| NPI: | 1740252410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDER STOUWE | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | RANAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 S. CLIFF AVE. | ||||||||
| Address2: | STE. 400A | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228946 | ||||||||
| FaxNumber: | 6053228941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CM000030 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 0745745 | 05 | IA | MEDICAID | 1936628 | 01 | SD | ARAZ/AMERICA'S PPO | OTHER | 241441 | 01 | SD | MIDLANDS CHOICE | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 557851035160 | 01 | SD | PREFERRED ONE | OTHER | 57105AF03 | 01 | SD | WPS TRICARE | OTHER | 0703699 | 01 | SD | MEDICA | OTHER | 30852 | 01 | SD | SANFORD HEALTH PLANS | OTHER | 4995939 | 01 | SD | BLUE CROSS | OTHER | 6540182 | 05 | SD | MEDICAID | 10025071600 | 05 | NE | MEDICAID | 140180700 | 05 | MN | MEDICAID | 259K6VA | 01 | MN | CC SYSTEMS/BLUE PLUS | OTHER | 1765 | 01 | SD | DAKOTACARE | OTHER | 6540180 | 05 | SD | MEDICAID | HP39648 | 01 | SD | HEALTHPARTNERS | OTHER |