Provider Demographics
NPI:1790934412
Name:SLUITER, LAWRENCE DEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEAN
Last Name:SLUITER
Suffix:
Gender:M
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 1:303 S MAIN ST
Mailing Address - Street 2:P.O.BOX 23
Mailing Address - City:ONIDA
Mailing Address - State:SD
Mailing Address - Zip Code:57564-2160
Mailing Address - Country:US
Mailing Address - Phone:605-258-2635
Mailing Address - Fax:605-258-2499
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ONIDA
Practice Address - State:SD
Practice Address - Zip Code:57564-2160
Practice Address - Country:US
Practice Address - Phone:605-258-2635
Practice Address - Fax:605-258-2499
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant