Provider Demographics
NPI:1104246297
Name:NORENBERG, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NORENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2571
Mailing Address - Country:US
Mailing Address - Phone:605-328-5800
Mailing Address - Fax:605-328-5814
Practice Address - Street 1:6110 S. MINNESOTA AVENUE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2571
Practice Address - Country:US
Practice Address - Phone:605-328-5800
Practice Address - Fax:605-328-5814
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD10539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program