| Aurora County Clinic | |
|
106 S Main St Plankinton SD 57368-0000 | |
| (605) 942-7711 | |
| (605) 942-7713 |
| Full Name | Aurora County Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 106 S Main St, Plankinton, South Dakota |
| Authorized Official Name and Position | John Mengenhausen (CEO) |
| Authorized Official Contact | 6057724525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aurora County Clinic Po Box 250 Plankinton SD 57368-0000 Ph: (605) 942-7711 | Aurora County Clinic 106 S Main St Plankinton SD 57368-0000 Ph: (605) 942-7711 |
| NPI Number | 1356459382 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 07/14/2008 |
| Medicare PECOS PAC ID | 8921997933 |
|---|---|
| Medicare Enrollment ID | O20040315000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356459382 | NPI | - | NPPES |
| 5350112 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| Provider Name | Nancy L Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972596724 PECOS PAC ID: 4688566110 Enrollment ID: I20040329000440 |
| Provider Name | Misty J Rudebusch |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013987478 PECOS PAC ID: 3476543620 Enrollment ID: I20040518000598 |
| Provider Name | Ruth G Mosqueda Lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215937297 PECOS PAC ID: 4183601271 Enrollment ID: I20040707000267 |
| Provider Name | Jean M Thompson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659353282 PECOS PAC ID: 5698749752 Enrollment ID: I20040824000715 |
| Provider Name | Lorinda K Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972503944 PECOS PAC ID: 8325015746 Enrollment ID: I20040915000350 |
| Provider Name | Daniel J Kvale |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750356465 PECOS PAC ID: 9335118223 Enrollment ID: I20040928000517 |
| Provider Name | Danny Wolfgram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861473753 PECOS PAC ID: 1951334903 Enrollment ID: I20050912000508 |
| Provider Name | Thomas M Dean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952300345 PECOS PAC ID: 2668490004 Enrollment ID: I20051104000098 |
| Provider Name | Teresa a Marts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780764167 PECOS PAC ID: 9830196930 Enrollment ID: I20061102000558 |
| Provider Name | Valerie L Brown |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629145032 PECOS PAC ID: 4688676950 Enrollment ID: I20070215000575 |
| Provider Name | Lance S Lim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013914209 PECOS PAC ID: 5294625984 Enrollment ID: I20070518000274 |
| Provider Name | Anora D Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063593762 PECOS PAC ID: 1254429210 Enrollment ID: I20071109000049 |
| Provider Name | Lawrence J Dubray |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689643082 PECOS PAC ID: 8426060591 Enrollment ID: I20080211000014 |
| Provider Name | Tony L Berg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053492827 PECOS PAC ID: 3173415577 Enrollment ID: I20080225000284 |
| Provider Name | Thomas E Jacobsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053405662 PECOS PAC ID: 5092729269 Enrollment ID: I20080930000147 |
| Provider Name | Karen L Pearson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861480501 PECOS PAC ID: 9537222773 Enrollment ID: I20090114000036 |
| Provider Name | Jodi L Jung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609103977 PECOS PAC ID: 3476684671 Enrollment ID: I20100702000407 |
| Provider Name | Catherine Friesen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356338966 PECOS PAC ID: 0941217459 Enrollment ID: I20100830000098 |
| Provider Name | Lori Kollmann |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932109907 PECOS PAC ID: 1658560495 Enrollment ID: I20110111000225 |
| Provider Name | Diane a Inch |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457683864 PECOS PAC ID: 2668503186 Enrollment ID: I20110818000925 |
| Provider Name | Amy J Noonan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336435080 PECOS PAC ID: 6709059470 Enrollment ID: I20111026000203 |
| Provider Name | Darcie L Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467729731 PECOS PAC ID: 0042478059 Enrollment ID: I20120222000547 |
| Provider Name | Leonard T Wonnenberg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609147461 PECOS PAC ID: 2961661509 Enrollment ID: I20120316000634 |
| Provider Name | Michelle L Udelhoven |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356696421 PECOS PAC ID: 3476704289 Enrollment ID: I20121102000493 |
| Provider Name | Kyla B Feickert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316285471 PECOS PAC ID: 3173769379 Enrollment ID: I20130412000474 |
| Provider Name | Amanda L Adams |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720327331 PECOS PAC ID: 6507002052 Enrollment ID: I20130429000507 |
| Provider Name | Erin Tobin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235430042 PECOS PAC ID: 9931395654 Enrollment ID: I20130510000311 |
| Provider Name | Dannica Callies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376971770 PECOS PAC ID: 9436387578 Enrollment ID: I20140116001026 |
| Provider Name | Paul Keith Brown |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649682428 PECOS PAC ID: 3375768401 Enrollment ID: I20140707000061 |
| Provider Name | Megan J Leddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205242658 PECOS PAC ID: 4284851700 Enrollment ID: I20140807000035 |
| Provider Name | James L Chiu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124347265 PECOS PAC ID: 1951531771 Enrollment ID: I20140923001047 |
| Provider Name | Kristen Morrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245670801 PECOS PAC ID: 9638301583 Enrollment ID: I20141010000044 |
| Provider Name | Melissa a Thoene |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386046696 PECOS PAC ID: 3678896552 Enrollment ID: I20141229002206 |
| Provider Name | Morgan M Zavadil |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821492802 PECOS PAC ID: 2163745431 Enrollment ID: I20150507001737 |
| Provider Name | Katie Annette Stearns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467822262 PECOS PAC ID: 4183934284 Enrollment ID: I20151102000998 |
| Provider Name | Anna L Waldner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518383728 PECOS PAC ID: 6608176540 Enrollment ID: I20151130000422 |
| Provider Name | Rachele Nicole Vietor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184008682 PECOS PAC ID: 3678875689 Enrollment ID: I20160107002868 |
| Provider Name | Alanna R Chapman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568741858 PECOS PAC ID: 5092975714 Enrollment ID: I20160324001318 |
| Provider Name | Traci M Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588044846 PECOS PAC ID: 3870890171 Enrollment ID: I20160331002378 |
| Provider Name | Meghan J Torgerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134584584 PECOS PAC ID: 8628367471 Enrollment ID: I20160517002218 |
| Provider Name | Spencer Todd Mason |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982064184 PECOS PAC ID: 7517259948 Enrollment ID: I20160706000503 |
| Provider Name | Rikki J Ohlrogge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063828192 PECOS PAC ID: 6800175498 Enrollment ID: I20161123000904 |
| Provider Name | Autumn R Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225578198 PECOS PAC ID: 0547538696 Enrollment ID: I20170614002493 |
| Provider Name | Leah Catherine Bennett |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902332760 PECOS PAC ID: 0345511465 Enrollment ID: I20170808003820 |
| Provider Name | Melissa Dawn Day |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184154304 PECOS PAC ID: 8628341062 Enrollment ID: I20170906001399 |
| Provider Name | Thyra Crissey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538529904 PECOS PAC ID: 3971879651 Enrollment ID: I20171024003666 |
| Provider Name | Margaret Lee |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407365455 PECOS PAC ID: 1850657644 Enrollment ID: I20171110001470 |
| Provider Name | Tia Marie Chase |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861904476 PECOS PAC ID: 5698032225 Enrollment ID: I20171206001814 |
| Provider Name | Jill M Moser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144731860 PECOS PAC ID: 0547528077 Enrollment ID: I20171211001339 |
| Provider Name | Lori a Manas-lammers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013958685 PECOS PAC ID: 2466525746 Enrollment ID: I20180423000407 |
| Provider Name | Veronica Sherwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194218966 PECOS PAC ID: 5395092472 Enrollment ID: I20180719004077 |
| Provider Name | Theresa E Hammerquist |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982194049 PECOS PAC ID: 7618224551 Enrollment ID: I20180723003296 |
| Provider Name | Amanda Marie Thoms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073094611 PECOS PAC ID: 0345584165 Enrollment ID: I20181205003219 |
| Provider Name | Meghan C O'connell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073827556 PECOS PAC ID: 5799914842 Enrollment ID: I20181231001238 |
| Provider Name | Ryan R Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285110486 PECOS PAC ID: 3678818275 Enrollment ID: I20190102000606 |
| Provider Name | Kristin M Pratt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396236337 PECOS PAC ID: 3779820709 Enrollment ID: I20190129000765 |
| Provider Name | Katlyn E Rostyne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457827834 PECOS PAC ID: 2365780988 Enrollment ID: I20190206001974 |
| Provider Name | Cassandra Aesoph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225698723 PECOS PAC ID: 0749515880 Enrollment ID: I20190711003571 |
| Provider Name | Haley Marie Keesaman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063054039 PECOS PAC ID: 9234561689 Enrollment ID: I20191122002681 |
| Provider Name | Jacklyn R Genzlinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548733116 PECOS PAC ID: 0648607978 Enrollment ID: I20200227000507 |
| Provider Name | Terry D Weaver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528063997 PECOS PAC ID: 2264428655 Enrollment ID: I20200323002178 |
| Provider Name | Kimberli M Hastings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942850862 PECOS PAC ID: 0042642027 Enrollment ID: I20200528001930 |
| Provider Name | Alexandra L Bachman-williams |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104448851 PECOS PAC ID: 1658793617 Enrollment ID: I20200619001189 |
| Provider Name | Mark Cali |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356440903 PECOS PAC ID: 7719084292 Enrollment ID: I20200820000485 |
| Provider Name | Jocelyn R Bergh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1972121945 PECOS PAC ID: 6103245741 Enrollment ID: I20200930002368 |
| Provider Name | Alyssa Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639771629 PECOS PAC ID: 1153732888 Enrollment ID: I20201201001179 |
| Provider Name | Patrick D Flanigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083245393 PECOS PAC ID: 9133557572 Enrollment ID: I20210112002807 |
| Provider Name | Denise M Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760070841 PECOS PAC ID: 2668885492 Enrollment ID: I20210115000293 |
| Provider Name | Shelby Schoenfelder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942898739 PECOS PAC ID: 0547675795 Enrollment ID: I20210219001962 |
| Provider Name | Morgan Marie Lentsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457026759 PECOS PAC ID: 2961807961 Enrollment ID: I20210827002616 |
| Provider Name | Rachel Oluwaseunayo Olugbenga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457869992 PECOS PAC ID: 1850653544 Enrollment ID: I20210831001796 |
| Provider Name | Jessica Ormsmith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124079116 PECOS PAC ID: 3072563824 Enrollment ID: I20211018001708 |
| Provider Name | Mckenzie Bormann |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932877644 PECOS PAC ID: 6002293784 Enrollment ID: I20220518002185 |
| Provider Name | Kelli M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710537253 PECOS PAC ID: 5698785954 Enrollment ID: I20220722002457 |
| Provider Name | Ken Noguchi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871156737 PECOS PAC ID: 2961884952 Enrollment ID: I20220818002635 |
| Provider Name | Christa Hamann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386694297 PECOS PAC ID: 9830092360 Enrollment ID: I20221031002465 |
| Provider Name | Alyssa Rochelle Hofer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144940545 PECOS PAC ID: 5092182279 Enrollment ID: I20221031002658 |
| Provider Name | Amber Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255934907 PECOS PAC ID: 7416324322 Enrollment ID: I20221107001269 |
| Provider Name | Kevin Vaughn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194760215 PECOS PAC ID: 1951548437 Enrollment ID: I20230120002376 |
| Provider Name | Briana Broschat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174243752 PECOS PAC ID: 4880066570 Enrollment ID: I20230206002134 |
| Provider Name | Bailey Jo Keckler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235600404 PECOS PAC ID: 8224493978 Enrollment ID: I20230502001222 |
| Provider Name | Lisa Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922497866 PECOS PAC ID: 5597120931 Enrollment ID: I20230508001954 |
| Provider Name | Melinda C Dalley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285320333 PECOS PAC ID: 5496112633 Enrollment ID: I20230605000413 |
| Provider Name | Sara J Cashman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881371359 PECOS PAC ID: 1052773744 Enrollment ID: I20230811002038 |
| Provider Name | Patrick Anolf Koistinen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639854532 PECOS PAC ID: 7315391968 Enrollment ID: I20230929002916 |
| Provider Name | Christina Louise Rosario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215621248 PECOS PAC ID: 4789667775 Enrollment ID: I20231121001140 |
| Provider Name | Bailey a Roshau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649935925 PECOS PAC ID: 7012360670 Enrollment ID: I20240131004122 |
| Provider Name | Presley Joyce Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073374211 PECOS PAC ID: 8224471677 Enrollment ID: I20240213002106 |
| Provider Name | Lindsey Heath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497574370 PECOS PAC ID: 5193250686 Enrollment ID: I20241120002840 |
| Provider Name | Carrie Kocer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780407270 PECOS PAC ID: 8820523988 Enrollment ID: I20241126001671 |
| Provider Name | Kathryn J Jewett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700390697 PECOS PAC ID: 4082138300 Enrollment ID: I20250408003220 |
| Provider Name | Connor Kirwan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346120938 PECOS PAC ID: 6901394030 Enrollment ID: I20251021004433 |
| Provider Name | Meghan Eisma |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811858459 PECOS PAC ID: 1850874215 Enrollment ID: I20260313000854 |
| Provider Name | Emily Lawrence |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366851834 PECOS PAC ID: 8224503214 Enrollment ID: I20260407002964 |
| Provider Name | Candace Mae Veit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023327780 PECOS PAC ID: 1759851645 Enrollment ID: I20260601003765 |
| Provider Name | Beth Wernke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356820021 PECOS PAC ID: 7012302995 Enrollment ID: I20260602003695 |