Healthcare Provider Details

I. General information

NPI: 1760551147
Provider Name (Legal Business Name): MCLAUGHLIN SCHOOL DISTRICT 15-2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SOUTH MAIN
MCLAUGHLIN SD
57642-0880
US

IV. Provider business mailing address

601 SOUTH MAIN P.O. BOX 880
MCLAUGHLIN SD
57642-0880
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4483
  • Fax: 604-823-4880
Mailing address:
  • Phone: 605-823-4483
  • Fax: 604-823-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR015731
License Number StateSD

VIII. Authorized Official

Name: MRS. KENDRA J SANDQUIST
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-823-4484