Organization
AVERA MCKENNAN HOSPITAL MEDICAL STAFF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN GARRY MHA, FACHE, FACMPE (CLINIC ADMINISTRATIVE MANAGER)
(605) 322-6792
Entity
Organization
Contact information
Practice address
1325 S CLIFF AVE, PLAZA 4, SIOUX FALLS, SD 57105-1007
(605) 322-6792
Mailing address
1325 S CLIFF AVE, PLAZA 4, SIOUX FALLS, SD 57105-1007
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CP001103
SD
Other
Enumeration date
06/29/2016
Last updated
06/29/2016
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