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NPI Code Detail

MEDICARE: CHARICE AMBER SUOMALA CNP

MEDICARE: CHARICE AMBER SUOMALA CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerCP002170SD
2261QU0200XUrgent Care Clinic/Center
3363L00000XNurse PractitionerCP002170SD

General Provider Information

NPI Number : 1841952710
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARICE AMBER SUOMALA CNP
Provider Business Mailing Address
First Line : 1730 HAINES AVE
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-0615
Country : US
Telephone Number : 605-791-7788
Fax Number :
Provider Business Practice Location Address
First Line : 1730 HAINES AVE
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-0615
Country : US
Telephone Number : 605-791-7788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2021
Last Update Date : 04/26/2022

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