Healthcare Provider Details

I. General information

NPI: 1194659987
Provider Name (Legal Business Name): CASEY RAE MAGNUSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 NAZARETH LN
RAPID CITY SD
57703-8551
US

IV. Provider business mailing address

3510 NAZARETH LN
RAPID CITY SD
57703-8551
US

V. Phone/Fax

Practice location:
  • Phone: 701-580-9521
  • Fax:
Mailing address:
  • Phone: 701-580-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF05260663
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: