Individual
MRS. TANYA L TRUCKENMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
911 E 20TH ST STE 505, SIOUX FALLS, SD 57105-1047
(605) 322-7250
(605) 322-7251
Mailing address
PO BOX 5126, SIOUX FALLS, SD 57117-5126
(605) 335-1952
(605) 373-9971
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0687
SD
363A00000X
Physician Assistant
1335
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6830640
—
SD
01
—
P00700560
RAILROAD MEDICARE
SD
Enumeration date
07/30/2007
Last updated
02/22/2013
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