Provider Demographics
NPI:1609358035
Name:DYKSTRA, RACHEL (CNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DYKSTRA
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:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325
Mailing Address - Country:US
Mailing Address - Phone:605-234-6584
Mailing Address - Fax:
Practice Address - Street 1:525 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2999
Practice Address - Country:US
Practice Address - Phone:605-995-2510
Practice Address - Fax:605-995-2511
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily