Healthcare Provider Details

I. General information

NPI: 1891948733
Provider Name (Legal Business Name): ROBERT G VALANDRA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E HWY 18
PINE RIDGE SD
57770-1201
US

IV. Provider business mailing address

PO BOX 1201
PINE RIDGE SD
57770-1201
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-5131
  • Fax: 605-867-3305
Mailing address:
  • Phone: 605-867-5131
  • Fax: 605-867-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRO22889
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: