| Doctor Name: | CRAIG A NOTEBOOM |
| NPI Number: | 1396986626 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | R031579 |
| Business Practice Address: | 111 Washington Ave Nw Wagner, SD - 573800111 |
| Business Phone Number: | 6053843621 |
| Business Fax Number: | 6053843293 |
| Mailing Address: | 111 Washington Ave Nw, WAGNER |
| State: | SD |
| Postal Code: | 573800111 |
| Phone Number: | 6053843621 |
| Fax Number: | 6053843293 |
| NPI Enumeration Date: | 03/17/2009 |
| NPI Last Update Date: | 03/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | R031579 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |