Healthcare Provider Details

I. General information

NPI: 1609839463
Provider Name (Legal Business Name): HOLLY V LASHMET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 10TH AVE W
MOBRIDGE SD
57601
US

IV. Provider business mailing address

403 10TH ST E
MOBRIDGE SD
57601-1813
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-8271
  • Fax:
Mailing address:
  • Phone: 605-845-3502
  • Fax: 605-845-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number66586
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number100997
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number100997
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100997
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000953
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: