Provider Demographics
NPI:1215588512
Name:KLINKHAMMER, CAROLYN MARIE (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:KLINKHAMMER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NORTH FOSTER - AVERA QUEEN OF PEACE HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301
Mailing Address - Country:US
Mailing Address - Phone:605-995-2260
Mailing Address - Fax:605-995-5796
Practice Address - Street 1:525 NORTH FOSTER - AVERA QUEEN OF PEACE HOSPITAL
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301
Practice Address - Country:US
Practice Address - Phone:605-995-2260
Practice Address - Fax:605-995-5796
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD08927259163WD0400X
SDR018304163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator