Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI # | 1174815088 |
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| LBN Legal business name | AVERA ST. LUKE'S | ||||
| Authorized official | DEBBIE STREIER - (VICE PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 05/11/2011 | ||||
| Last updated | 04/02/2020 - About 6 years ago | ||||
| Identifiers |
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AVERA ST. LUKE'S
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