| NPI | 1619050929 |
|---|---|
| Doing Business As | SIOUX VALLEY LAKE PARK CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOEL MASON GUSTAFSON Administrator 712-324-5356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |