Individual
FANNY M JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1210 W 18TH ST, STE 100, SIOUX FALLS, SD 57104
(605) 312-8500
(605) 312-8501
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
054903
GA
Other
Enumeration date
07/07/2006
Last updated
03/25/2022
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