Provider Demographics
NPI:1992425458
Name:DAHLSTROM, WHITNEY (RN)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 ELDERBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-5970
Mailing Address - Country:US
Mailing Address - Phone:605-721-1922
Mailing Address - Fax:
Practice Address - Street 1:2611 ELDERBERRY BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-5970
Practice Address - Country:US
Practice Address - Phone:605-721-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR056409163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care