Provider Demographics
NPI:1699818252
Name:SIEVERS, DELAINA PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:DELAINA
Middle Name:PATRICIA
Last Name:SIEVERS
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 1:22719 459TH AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57057-6502
Mailing Address - Country:US
Mailing Address - Phone:605-586-4252
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-3440
Practice Address - Fax:605-322-3654
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant