Individual
HANS R WAGENAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 W 69TH ST, SIOUX FALLS, SD 57108-2403
(605) 336-0635
(605) 336-7182
Mailing address
201 W 69TH ST, SIOUX FALLS, SD 57108-2403
(605) 336-0635
(605) 336-7182
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0447
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6821680
—
SD
05
—
714427000
—
MN
01
—
970015240
RAILROAD MEDICARE
SD
Enumeration date
05/03/2006
Last updated
02/01/2012
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