Provider Demographics
NPI:1669530671
Name:FURTH, HEIDI MARIE (CNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:FURTH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:WALTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4950 S. MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2864
Mailing Address - Country:US
Mailing Address - Phone:605-330-9619
Mailing Address - Fax:605-330-9503
Practice Address - Street 1:6701 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2591
Practice Address - Country:US
Practice Address - Phone:605-322-6960
Practice Address - Fax:605-322-6961
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
252490OtherMIDLAND'S CHOICE
040122003OtherPRIMEWEST
370624200OtherDEPT. OF LABOR
SDCP000486OtherCNP LICENSE
SD9243923OtherDAKOTACARE-DERM
SDR030516OtherRN LICENSE
SD4992508OtherBLUE CROSS/SOUTH DAKOTA
57108B008OtherWPS TRICARE
MN6I478FUOtherBLUE CROSS-DERM
MN580082100Medicaid
IA0575076Medicaid
1669530671OtherARAZ/AMERICA'S PPO
SD6829172Medicaid
MN6I478FUOtherCC SYSTEMS/ BLUE PLUS
MN6I478FUOtherCC SYSTEMS/BLUE PLUS-DERM
MN6I478FUOtherBLUE CROSS
MN6I478FUOtherBLUE CROSS-DERM