Provider Demographics
NPI:1427097260
Name:VENHUIZEN MATT, TONYA R (CNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:R
Last Name:VENHUIZEN MATT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:R
Other - Last Name:VENHUIZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S. CLIFF AVE
Practice Address - Street 2:STE 601
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:605-322-6931
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1427097260OtherARAZ/AMERICA'S PPO
MN46L65VEOtherCC SYSTEMS/ BLUE PLUS
SD4992678OtherBLUE CROSS
407141053077OtherPREFERRED ONE
SD9237741OtherDAKOTACARE
SD6825863Medicaid
HP94300OtherHEALTHPARTNERS
IA2920926Medicaid
MN46L65VEOtherBLUE CROSS
SD370624200OtherDEPT OF LABOR
255119OtherMIDLAND'S CHOICE
SD40252OtherMEDICARE GROUP #
SD57105W012OtherWPS TRICARE
MN682443000Medicaid
MN92411422905OtherPRIMEWEST
SD1427097260OtherMEDICA
SD6825863Medicaid