Provider Demographics
NPI:1992386486
Name:BLEEKER, LAURA (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BLEEKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6029
Mailing Address - Country:US
Mailing Address - Phone:605-504-1100
Mailing Address - Fax:
Practice Address - Street 1:6100 S LOUISE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6029
Practice Address - Country:US
Practice Address - Phone:605-504-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily