Healthcare Provider Details

I. General information

NPI: 1295275113
Provider Name (Legal Business Name): COURTNEY LANE VESELY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LANE NORDINE

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 COLUMBUS ST
RAPID CITY SD
57701-3540
US

IV. Provider business mailing address

811 COLUMBUS ST
RAPID CITY SD
57701-3540
US

V. Phone/Fax

Practice location:
  • Phone: 605-545-9020
  • Fax:
Mailing address:
  • Phone: 605-545-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001794
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR041703
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: