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Organization
SIOUX VALLEY REGIONAL HEALTH SERVICES
Active
Organization
SIOUX VALLEY REGIONAL HEALTH SERVICES
Active
Other names
Sioux Valley Lake Park Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL MASON GUSTAFSON (ADMINISTRATOR)
(712) 324-5356
Entity
Organization
Contact information
Practice address
204 MARKET ST., LAKE PARK, IA 51347
(712) 832-9559
(712) 832-3801
Mailing address
204 MARKET ST., P.O. BOX 627, LAKE PARK, IA 51347
(712) 832-9559
(712) 832-3801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0689091
—
IA
Enumeration date
10/23/2006
Last updated
08/22/2020
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