Healthcare Provider Details

I. General information

NPI: 1194807511
Provider Name (Legal Business Name): LINDSAY MARIE RHEAULT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WELLNESS CTR BOX 2818
BROOKINGS SD
57007-0001
US

IV. Provider business mailing address

45434 222ND ST
RAMONA SD
57054-6108
US

V. Phone/Fax

Practice location:
  • Phone: 605-688-4157
  • Fax:
Mailing address:
  • Phone: 605-366-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000480
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: