Provider Demographics
NPI:1700839834
Name:KREIE, STEPHANIE (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KREIE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2830
Mailing Address - Country:US
Mailing Address - Phone:605-697-1900
Mailing Address - Fax:605-697-1919
Practice Address - Street 1:922 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2830
Practice Address - Country:US
Practice Address - Phone:605-697-1900
Practice Address - Fax:605-697-1919
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0612363A00000X
IA001682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6828410Medicaid
SDS101142Medicare PIN
SDP00419565Medicare PIN