Provider Demographics
NPI:1508178666
Name:PLOOSTER, MICHELE R (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:PLOOSTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 SHERIDAN LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3432
Mailing Address - Country:US
Mailing Address - Phone:605-391-0561
Mailing Address - Fax:605-388-5546
Practice Address - Street 1:1621 SHERIDAN LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3432
Practice Address - Country:US
Practice Address - Phone:605-388-2655
Practice Address - Fax:605-388-5546
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS104202Medicare PIN