Provider Demographics
NPI:1033113519
Name:POLLARD, LOLA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:M
Last Name:POLLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9556
Mailing Address - Fax:605-328-9501
Practice Address - Street 1:101 PEABODY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274
Practice Address - Country:US
Practice Address - Phone:605-345-4141
Practice Address - Fax:605-345-4135
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0310363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6821262Medicaid
SDS8158Medicare PIN
SDP00113965Medicare PIN
R02628Medicare UPIN
SDR02628Medicare PIN