Provider Demographics
NPI:1780865626
Name:VAN GENDEREN, BETSY M (CNP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:M
Last Name:VAN GENDEREN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:M
Other - Last Name:WEISMANTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:2100 HIGHLAND WAY STE K
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6409
Practice Address - Country:US
Practice Address - Phone:605-996-0440
Practice Address - Fax:605-996-0401
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4992440OtherBLUE CROSS
SD254961OtherMIDLANDS CHOICE
IA1134191869Medicaid
C70501053906OtherPREFERRED ONE
1780865626OtherARAZ/AMERICA'S PPO
9255156OtherDAKOTACARE
75L18VAOtherCC SYSTEMS/BLUE PLUS
SD57105N005OtherWPS TRICARE
SD6829990Medicaid
MN854618200Medicaid
MN854618200Medicaid