Provider Demographics
NPI:1730109257
Name:DORNACKER-EGGL, ANGELA SUE (MD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUE
Last Name:DORNACKER-EGGL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:DORNACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:
Mailing Address - Fax:
Practice Address - Street 1:3318 N 14TH ST.
Practice Address - Street 2:SANFORD HEALTH NORTH WALK IN CLINIC
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:701-323-8300
Practice Address - Fax:701-323-8305
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18609Medicaid
ND14760Medicare PIN
NDG12880Medicare UPIN