Provider Demographics
NPI:1740252410
Name:VANDER STOUWE, TERESA RANAE (CNM)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:RANAE
Last Name:VANDER STOUWE
Suffix:
Gender:F
Credentials:CNM
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 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 400A
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1064
Practice Address - Country:US
Practice Address - Phone:605-322-8946
Practice Address - Fax:605-322-8941
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCM000030367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0745745Medicaid
SD1936628OtherARAZ/AMERICA'S PPO
SD241441OtherMIDLANDS CHOICE
SD370624200OtherDEPT OF LABOR
SD557851035160OtherPREFERRED ONE
SD57105AF03OtherWPS TRICARE
SD0703699OtherMEDICA
SD30852OtherSANFORD HEALTH PLANS
SD4995939OtherBLUE CROSS
SD6540182Medicaid
NE10025071600Medicaid
MN140180700Medicaid
MN259K6VAOtherCC SYSTEMS/BLUE PLUS
SD1765OtherDAKOTACARE
SD6540180Medicaid
SDHP39648OtherHEALTHPARTNERS
SD1936628OtherARAZ/AMERICA'S PPO
SDS103175Medicare PIN
SDS41577Medicare PIN