Provider Demographics
NPI:1497582340
Name:LITTAU, KIP (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIP
Middle Name:
Last Name:LITTAU
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40430 237TH ST
Mailing Address - Street 2:
Mailing Address - City:LETCHER
Mailing Address - State:SD
Mailing Address - Zip Code:57359-6104
Mailing Address - Country:US
Mailing Address - Phone:605-842-6625
Mailing Address - Fax:
Practice Address - Street 1:104 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:PLANKINTON
Practice Address - State:SD
Practice Address - Zip Code:57368-2083
Practice Address - Country:US
Practice Address - Phone:605-299-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty