Healthcare Provider Details

I. General information

NPI: 1851370746
Provider Name (Legal Business Name): RENA J ROBBENNOLT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E GARFIELD AVE
GETTYSBURG SD
57442-1325
US

IV. Provider business mailing address

100 MAC LANE AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-765-2273
  • Fax: 605-765-2273
Mailing address:
  • Phone: 605-945-5201
  • Fax: 605-765-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0200
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000200
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: