Provider Demographics
NPI:1841262607
Name:VAN GERPEN, LISA ANN (CNM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:VAN GERPEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 S MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3761
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1064
Practice Address - Country:US
Practice Address - Phone:605-322-8946
Practice Address - Fax:605-322-8941
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0020367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005970OtherBLUE CROSS
SD370624200OtherDEPT OF LABOR
MN50F31HAOtherCC SYSTEMS/BLUE PLUS
SD0702889OtherMEDICA
SD57105AF02OtherWPS TRICARE
MN023225400Medicaid
NE10025071600Medicaid
SD25996OtherSANFORD HEALTH PLANS
SD557851022965OtherPREFERRED ONE
SD822898OtherARAZ/ AMERICA'S PPO
SD6540080Medicaid
SD11205OtherMIDLANDS CHOICE
IA0745760Medicaid
SDHP32386OtherHEALTHPARTNERS
SD1765OtherDAKOTACARE
SD6540082Medicaid
SD557851022965OtherPREFERRED ONE
SD0005970OtherBLUE CROSS
SD1765OtherDAKOTACARE