Individual
JENNA M DORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2822 JACKSON BLVD, SUITE 101, RAPID CITY, SD 57702-3497
(605) 341-1208
(605) 341-3552
Mailing address
2822 JACKSON BLVD, SUITE 101, RAPID CITY, SD 57702-3497
(605) 341-1208
(605) 341-3552
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0614
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001972
WELLMARK
SD
05
—
6828382
—
SD
Enumeration date
12/18/2006
Last updated
01/14/2016
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