Provider Demographics
NPI:1720416563
Name:OBERLE, CRYSTAL M (PA-C)
Entity Type:Individual
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First Name:CRYSTAL
Middle Name:M
Last Name:OBERLE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:705 N SIOUX POINT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5091
Mailing Address - Country:US
Mailing Address - Phone:605-217-5500
Mailing Address - Fax:605-217-5515
Practice Address - Street 1:705 N SIOUX POINT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-217-5500
Practice Address - Fax:605-217-5515
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2018-08-02
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Provider Licenses
StateLicense IDTaxonomies
NE1778363AM0700X
IA002409363AM0700X
SD0883363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical