JACQUELINE DEBORAH WEIDAUER (NPI# 1548737018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548737018 |
| Entity Type | Individual |
| Full Name | JACQUELINE DEBORAH WEIDAUER |
| Credential | CNP-BC |
| Practice Address |
1600 W 22nd St Sioux Falls SD 57105-1521 |
| Mailing Address |
509 W 8th St Dell Rapids SD 57022-2122 |
| Practice Telephone | 6053283000 |
| Mailing Telephone | 5078296008 |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2018-11-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
CP001487 | SD | Allopathic & Osteopathic Physicians |
| Street Address |
1600 W 22ND ST |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425740 | John H Shelso | Pediatrics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2005-05-27 |
| 1831714245 | Shea Bonine | Genetic Counselor, MS | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2020-06-11 |
| 1952922932 | Kyla Stoops | Nurse Practitioner | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2020-05-01 |
| 1265064620 | Cassandra Larsen | Registered Nurse | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2020-02-04 |
| 1245871466 | Noelle Marie Mcgee | Nurse Practitioner | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2019-09-30 |
| 1780240622 | Nathaniel R. Nelson | Pediatrics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2019-05-16 |
| 1457914046 | Michelle Ahnberg | Clinical Nurse Specialist | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2019-04-18 |
| 1801373766 | Ashlee Blumhoff | Nurse Practitioner | 1600 W 22nd St, Sioux Falls, SD 57105 | 2018-07-24 |
| 1619464294 | Pamela Ann Koepsell | Clinical Nurse Specialist | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2018-04-18 |
| 1104335728 | Sarah Dorr | Nurse Practitioner | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2017-09-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871117549 | Ashlesha Ravindra Bagwe | Student in an Organized Health Care Education/Training Program | Pediatrics Residency Program, 1305 W 18th St, Rt 6364, Sioux Falls, SD 57105 | 2020-05-29 |
| 1306494489 | Kelsey Elaine Kruse | Counselor | 3101 West 41st, Sioux Falls, SD 57105 | 2019-08-30 |
| 1902388341 | Sarah Tacke | Nurse Practitioner | 1301 West 18th Street, Sioux Falls, SD 57105 | 2018-09-02 |
| 1235624727 | Mahum Shahid | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St, Sioux Falls, SD 57105 | 2018-06-27 |
| 1942790126 | Smitha Narayana Gowda | Student in an Organized Health Care Education/Training Program | 1400 22nd Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1326538554 | Mali Elizabeth Teller | Speech-Language Pathologist | 2501 W. 26th Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1871081505 | Abdelmohaymin Abdalla Abufatima Abdalla | Student in an Organized Health Care Education/Training Program | Usd-ssom-internal Medicine Residency, 1400 22nd Street, Sioux Falls, SD 57105 | 2018-04-27 |
| 1710474697 | Moataz Ellithi | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St., Sioux Falls, SD 57105 | 2018-04-17 |
| 1366948663 | Holly Ahlers | Registered Nurse | 2000 S. Summit Ave, Sioux Falls, Sd 57105, Sioux Falls, SD 57105 | 2018-04-04 |
| 1558864124 | Darcy Lee Jensen | Counselor | 822 East 41st. Street, Suite 235, Souix Falls, SD 57105 | 2018-03-09 |
| Find all providers in zip 57105 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104896083 | Jose Marius D Dosado | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1285054858 | Taylor Hansen | Pediatrics | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 | 2014-04-22 |
| 1487099289 | Kathryn Marie Anderson | Pediatrics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2013-05-07 |
| 1790925311 | Fernando Augusto Soares | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2009-02-22 |
| 1841471521 | Sanford Medical Center | Pediatrics | 1305 W 18th St, Sioux Falls, SD 57105-0401 | 2007-11-21 |
| 1427258318 | Maria Margarita Talavera Barber | Pediatrics | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 | 2007-07-19 |
| 1073585949 | Avera Mckennan | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-02-06 |
| 1952371825 | Kandi Mcmenamy | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1780654665 | Samuel E Rogers | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205321494 | B&b Neonatology | Pediatrics | 3213 W Main St Ste 128, Rapid City, SD 57702-2314 | 2018-06-29 |
| 1881917078 | Kimberly Sierra Balay | Pediatrics | 4140 Penrose Pl, Rapid City, SD 57702-6828 | 2010-03-02 |
| 1639229727 | Black Hills Pediatrics and Neonatology | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2007-01-11 |
| 1063437085 | Stephen M Kovarik | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2006-07-12 |
| 1346265394 | Steven I Benn | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2006-07-12 |
| City | SIOUX FALLS |
| Zip Code | 57105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.