Provider Demographics
NPI:1699702613
Name:NETTLEMAN, MARY DEKKER (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:DEKKER
Last Name:NETTLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1205 S GRANGE AVE STE 407
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0410
Practice Address - Country:US
Practice Address - Phone:605-328-8900
Practice Address - Fax:605-328-8901
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD8349207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine