1992099402 NPI number — DR. STEPHANIE LANAE BURGER M.D.

Table of content: DR. STEPHANIE LANAE BURGER M.D. (NPI 1992099402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992099402 NPI number — DR. STEPHANIE LANAE BURGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGER
Provider First Name:
STEPHANIE
Provider Middle Name:
LANAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HULSTEIN
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LANAE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992099402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 TOWER RD- EAR NOSE & THROAT CONSULTANTS
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
DAKOTA DUNES
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-217-4320
Provider Business Mailing Address Fax Number:
605-217-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 SERGEANT ROAD- EAR NOSE & THROAT CONSULTANTS
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-217-4320
Provider Business Practice Location Address Fax Number:
605-217-2948
Provider Enumeration Date:
06/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  R-9147 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 43079 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 10561 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)