Provider Demographics
NPI:1215354386
Name:DAHMS, NICOLE ROSE (LMT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ROSE
Last Name:DAHMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ROSE
Other - Last Name:DAHMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMA AAMA
Mailing Address - Street 1:2908 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4089
Mailing Address - Country:US
Mailing Address - Phone:605-336-2638
Mailing Address - Fax:605-275-1498
Practice Address - Street 1:2908 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4089
Practice Address - Country:US
Practice Address - Phone:605-336-2638
Practice Address - Fax:605-275-1498
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11224207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine