Healthcare Provider Details

I. General information

NPI: 1851316897
Provider Name (Legal Business Name): STEVEN R LAUGHLIN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 5TH ST
RAPID CITY SD
57701-7316
US

IV. Provider business mailing address

2905 5TH ST
RAPID CITY SD
57701-7316
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-7337
  • Fax: 605-341-2447
Mailing address:
  • Phone: 605-341-7337
  • Fax: 605-341-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0242
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000104
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: