Provider Demographics
NPI:1124789540
Name:DARGATZ, STEPHANIE LYN (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYN
Last Name:DARGATZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44083 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-5700
Mailing Address - Country:US
Mailing Address - Phone:605-265-0418
Mailing Address - Fax:
Practice Address - Street 1:301 FLYNN DR
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1508
Practice Address - Country:US
Practice Address - Phone:605-432-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002257207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine