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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