Provider Demographics
NPI:1790018935
Name:MEHRMAN, THERESA ANN (CNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:MEHRMAN
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 1:3720 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8192
Mailing Address - Country:US
Mailing Address - Phone:605-322-5290
Mailing Address - Fax:605-322-5252
Practice Address - Street 1:3720 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8192
Practice Address - Country:US
Practice Address - Phone:605-322-5290
Practice Address - Fax:605-322-5252
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1790018935OtherDAKOTACARE
SD6828312Medicaid
SD6832603Medicaid
MN1790018935OtherBCBS OF MN
SD460484580OtherWELLMARK OF SD AND IA
460484580OtherGROUP TAX ID
IA1790018935Medicaid
1235196056OtherGROUP NPI
SD1790018935Medicaid
SD6832603Medicaid
IA1790018935Medicaid
1235196056Medicare NSC
SD460484580OtherWELLMARK OF SD AND IA
SD1790018935Medicaid
SDS103631Medicare PIN