Provider Demographics
NPI:1487658837
Name:MARCKSTADT, SHERYL L (CNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:MARCKSTADT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:MCMULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5027 S BUR OAK PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2228
Mailing Address - Country:US
Mailing Address - Phone:605-271-9000
Mailing Address - Fax:605-271-9001
Practice Address - Street 1:5027 S BUR OAK PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2228
Practice Address - Country:US
Practice Address - Phone:605-271-9000
Practice Address - Fax:605-271-9001
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6822785Medicaid
SDS41046Medicare PIN
SD500030310Medicare PIN
SD500030318Medicare PIN
SDS8507Medicare PIN
SDS40968Medicare PIN
SDP20172Medicare UPIN
SD500020576Medicare PIN