| NPI | 1255307450 |
|---|---|
| Doing Business As | AVERA MEDICAL GROUP FUNCTIONAL MEDICINE |
| Entity Type | Organization |
| Authorized Contact | DAVID FLICEK CEO/President 605-322-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2021-02-16 |