Provider Demographics
NPI:1053806455
Name:POPPE, RYAN FREDERICK (RN)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:FREDERICK
Last Name:POPPE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BILLARS ST
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57059-2026
Mailing Address - Country:US
Mailing Address - Phone:605-583-2226
Mailing Address - Fax:
Practice Address - Street 1:1056 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9120
Practice Address - Country:US
Practice Address - Phone:605-753-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR036441163W00000X
SDCP001399363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner