Provider Demographics
NPI:1770548794
Name:LEON, SUSAN K (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:LEON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:YLITALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3015 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1846
Practice Address - Country:US
Practice Address - Phone:605-725-1700
Practice Address - Fax:605-725-1761
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6827014Medicaid
SDP00692831Medicare PIN
SDS98526Medicare UPIN
SD6827014Medicaid