Healthcare Provider Details

I. General information

NPI: 1033511597
Provider Name (Legal Business Name): CYNTHIA RAYMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24276 AIRPORT ROAD
EAGLE BUTTE SD
57625
US

IV. Provider business mailing address

PO BOX 1012
EAGLE BUTTE SD
57625-1012
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-7724
  • Fax: 605-964-0545
Mailing address:
  • Phone: 605-964-7724
  • Fax: 605-964-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA020070
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: