Basic Information
| Provider Information | |||||||||
| NPI: | 1821564451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 W 53RD ST APT 418 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571064055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3203339065 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 S BYRON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHAMBERLAIN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573259741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052346551 | ||||||||
| FaxNumber: | 6052347260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CP001478 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | CP001478 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | CP001478 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | CP001478 | 01 | SD | SD LICENSE | OTHER |