Individual
MRS. JENNIFER L BIETZ
Active
Individual
MRS. JENNIFER L BIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0489
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23141
SIOUX VALLEY HEALTH PLAN
SD
01
—
49997104
BLUE CROSS
SD
01
—
6504
AVERA HEALTH PLANS
SD
05
—
6823890
—
SD
Enumeration date
06/14/2005
Last updated
12/06/2011
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