Provider Demographics
NPI:1992701619
Name:VANPEURSEM, NANCI J (MD)
Entity type:Individual
Prefix:DR
First Name:NANCI
Middle Name:J
Last Name:VANPEURSEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15253 479TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-5931
Mailing Address - Country:US
Mailing Address - Phone:605-432-6360
Mailing Address - Fax:
Practice Address - Street 1:803 E MILBANK AVE
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1413
Practice Address - Country:US
Practice Address - Phone:605-432-4587
Practice Address - Fax:605-432-4580
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4722207Q00000X
MN42466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN318647400Medicaid
SD5601412Medicaid
SD5601412Medicaid
MN318647400Medicaid
H23405Medicare UPIN
SDBV6092376OtherDEA