Provider Demographics
NPI:1174278626
Name:DYKSTRA, ANNA MALENA WATERLAND (CNM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MALENA WATERLAND
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:CNM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6015 MOUNT RUSHMORE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8984
Mailing Address - Country:US
Mailing Address - Phone:605-343-9224
Mailing Address - Fax:605-342-1359
Practice Address - Street 1:6015 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8983
Practice Address - Country:US
Practice Address - Phone:605-343-9224
Practice Address - Fax:605-342-1359
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife