Provider Demographics
NPI:1114136405
Name:SOUSEK, ROBERT EDMOND (ADN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDMOND
Last Name:SOUSEK
Suffix:
Gender:M
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2011
Mailing Address - Country:US
Mailing Address - Phone:605-371-2491
Mailing Address - Fax:
Practice Address - Street 1:1725 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2011
Practice Address - Country:US
Practice Address - Phone:605-371-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR035223163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical