Provider Demographics
NPI:1255303707
Name:WITHORNE-MALONEY, LAURA R (CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:WITHORNE-MALONEY
Suffix:
Gender:F
Credentials:CNP
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Other - Credentials:
Mailing Address - Street 1:2400 S MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3761
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-7580
Practice Address - Fax:605-322-7579
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SDCP000224363LF0000X, 363LP0808X
SD0224364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007942OtherBLUE CROSS
IA1908517Medicaid
MN48D58WIOtherCC SYSTEMS/ BLUE PLUS
SD6826062Medicaid
SD769191017347OtherPREFERRED ONE
SD797890OtherARAZ/ AMERICA'S PPO
MN92411422904OtherPRIMEWEST
SD9237794OtherDAKOTACARE
SDHP31902OtherHEALTHPARTNERS
SD25457OtherSANFORD HEALTH PLAN
MN393603100Medicaid
MN151768OtherUCARE
SD22358OtherMIDLANDS CHOICE
NE46022474340Medicaid
SDP00146949OtherRR MEDICARE
ND12242Medicaid
SD57108D008OtherWPS TRICARE
SD769191017347OtherPREFERRED ONE
ND12242Medicaid