Provider Demographics
NPI:1669408308
Name:ENGLERT, DAVID A (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ENGLERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:ATTN: P.F.S. - PROV ENROLLMENT
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-6428
Mailing Address - Fax:605-322-6499
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000564367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5753982Medicaid
MN914S2ENOtherBLUE CROSS MN
SD4995050OtherBLUE CROSS SD
IA584409Medicaid
MN176642200Medicaid
MN176642200Medicaid
SD4995050OtherBLUE CROSS SD