Healthcare Provider Details

I. General information

NPI: 1356214878
Provider Name (Legal Business Name): MARJORIE LYNN VAN LITH CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST
HECLA SD
57446-8006
US

IV. Provider business mailing address

PO BOX 126
HECLA SD
57446-0126
US

V. Phone/Fax

Practice location:
  • Phone: 712-470-0927
  • Fax:
Mailing address:
  • Phone: 712-470-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number102397
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: