Provider Demographics
NPI:1649055732
Name:DALCHOW, BRIANNA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:DALCHOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:LEE
Other - Last Name:DALCHOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 G AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-2317
Mailing Address - Country:US
Mailing Address - Phone:605-728-2047
Mailing Address - Fax:
Practice Address - Street 1:200 J AVE STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-2225
Practice Address - Country:US
Practice Address - Phone:605-284-2621
Practice Address - Fax:605-284-2623
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant