Basic Information
| Provider Information | |||||||||
| NPI: | 1861477200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLBRINK | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227905 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227905 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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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 | 363A00000X | 0603 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0125932 | 01 | SD | MEDICA | OTHER | 310C0WO | 01 | MN | BLUE CROSS | OTHER | 46022474339 | 05 | NE | MEDICAID | 252487 | 01 | SD | MIDLANDS CHOICE | OTHER | 000080878 | 01 | MN | PRIMEWEST | OTHER | 310C0WO | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 57105I016 | 01 | SD | WPS TRICARE | OTHER | HP76323 | 01 | SD | HEALTHPARTNERS | OTHER | 0594416 | 05 | IA | MEDICAID | 13414 | 05 | ND | MEDICAID | 4993297 | 01 | SD | BLUE CROSS | OTHER | 9240696 | 01 | SD | DAKOTACARE | OTHER | 460224743296 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 651613000 | 05 | MN | MEDICAID | 722801049464 | 01 | SD | PREFERRED ONE | OTHER |