Individual
TIA MARIE CHASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 4TH ST SE, HURON, SD 57350-2509
(605) 352-8691
(605) 352-8704
Mailing address
20357 404TH AVE, HURON, SD 57350-6218
(605) 350-5155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1124
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2015122
—
SD
Enumeration date
11/05/2017
Last updated
01/25/2019
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