Provider Demographics
NPI:1437629987
Name:KALLSEN, ELIZABETH MARIE (CNP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:KALLSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E TRANQUILITY PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4896
Mailing Address - Country:US
Mailing Address - Phone:605-261-7363
Mailing Address - Fax:
Practice Address - Street 1:1315 S CLIFF AVE STE 2000
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1058
Practice Address - Country:US
Practice Address - Phone:605-322-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily