Provider Demographics
NPI:1508850603
Name:DANNER, KRISTINE THAYER (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:THAYER
Last Name:DANNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:345 W STEAMBOAT DR
Practice Address - Street 2:STE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5333
Practice Address - Country:US
Practice Address - Phone:605-217-2175
Practice Address - Fax:605-217-2185
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA31265207Q00000X
SD5316207Q00000X
NE1453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA150885063Medicaid
SD7705393Medicaid
SD7705393Medicaid