Healthcare Provider Details

I. General information

NPI: 1952560401
Provider Name (Legal Business Name): AMY NICOLE PASSERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINE RIDGE IHS HOSPITAL E HIGHWAY 18
PINE RIDGE SD
57770-1201
US

IV. Provider business mailing address

6717 HIGHWAY 20
CHADRON NE
69337-5333
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-3108
  • Fax:
Mailing address:
  • Phone: 605-867-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR029728
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: