Healthcare Provider Details

I. General information

NPI: 1679793988
Provider Name (Legal Business Name): LISA M VEIT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MAIN STREET
EAGLE BUTTE SD
57625
US

IV. Provider business mailing address

PO BOX 308
DUPREE SD
57623-0308
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-3004
  • Fax: 605-964-1110
Mailing address:
  • Phone: 605-365-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR025696
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: