Healthcare Provider Details

I. General information

NPI: 1053516211
Provider Name (Legal Business Name): HEATHER TAYNE GARREAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD VAMC BLACK HILLS
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

PO BOX 915 338 WASHINGTON STREET
EAGLE BUTTE SD
57625-0915
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-7170
  • Fax: 605-720-7171
Mailing address:
  • Phone: 605-365-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR032681
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: