Provider Demographics
NPI:1710933882
Name:STATEMA, KARLA (PAC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:STATEMA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:FRIDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 S EUCLID AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-328-3840
Mailing Address - Fax:605-328-3841
Practice Address - Street 1:1201 S EUCLID AVE
Practice Address - Street 2:STE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-328-3840
Practice Address - Fax:605-328-3841
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD970018387Medicare PIN
SDS41251Medicare PIN
P20170Medicare UPIN