Provider Demographics
NPI:1528397858
Name:SKOGLUND, DANIELLE L (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:SKOGLUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2424
Mailing Address - Country:US
Mailing Address - Phone:605-336-0635
Mailing Address - Fax:605-271-0543
Practice Address - Street 1:201 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2424
Practice Address - Country:US
Practice Address - Phone:605-336-0635
Practice Address - Fax:605-271-0543
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6832810Medicaid
SD6832810Medicaid