Provider Demographics
NPI:1336115609
Name:HEADRICK, ELAINE G (CNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:G
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:CNP
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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:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:911 E. 20TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1044
Practice Address - Country:US
Practice Address - Phone:605-322-3455
Practice Address - Fax:605-322-3456
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-12-20
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Provider Licenses
StateLicense IDTaxonomies
SD0271363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD230278OtherMIDLANDS CHOICE
SD28563OtherSANFORD HEALTH PLAN
SD370624200OtherDEPT OF LABOR
MN67B26HEOtherCC SYSTEMS/ BLUE PLUS
MN140309OtherUCARE
SD57105E002OtherWPS TRICARE
SDAH1451026885OtherPREFERRED ONE
SD0007481OtherBLUE CROSS
SDHP37108OtherHEALTHPARTNERS
SD6826982Medicaid
IA0585661Medicaid
SD1194219OtherARAZ/ AMERICA'S PPO
MN579152900Medicaid
SD0701587OtherMEDICA
NE10025120100Medicaid
MN67B26HEOtherBLUE CROSS
SD500016956OtherRR MEDICARE
SD9240518OtherDAKOTACARE
SDHP37108OtherHEALTHPARTNERS
MN579152900Medicaid