Healthcare Provider Details

I. General information

NPI: 1538296033
Provider Name (Legal Business Name): KIMM LAREE SCHWEITZER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CLAUDIA BLVD
LOWER BRULE SD
57548
US

IV. Provider business mailing address

22953 308TH AVE
PRESHO SD
57568-5105
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-5526
  • Fax: 605-473-5677
Mailing address:
  • Phone: 605-869-2511
  • Fax: 605-473-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberSD-RN R031822
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: