Basic Information
| Provider Information | |||||||||
| NPI: | 1972520682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYMAN | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 684 LAQUINTA COURT | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570494106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057594858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052427246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/27/2015 | ||||||||
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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 | 367500000X | R027317 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 4993704 | 01 | SD | WELLMARK | OTHER | R027317 | 01 | SD | LICENSE | OTHER | 5752872 | 05 | SD | MEDICAID |