Healthcare Provider Details

I. General information

NPI: 1396673745
Provider Name (Legal Business Name): LANETTE BETH JULIUS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 PROMISE RD
RAPID CITY SD
57701-8981
US

IV. Provider business mailing address

2165 PROMISE RD
RAPID CITY SD
57701-8981
US

V. Phone/Fax

Practice location:
  • Phone: 605-718-1095
  • Fax: 612-725-1211
Mailing address:
  • Phone: 605-718-1095
  • Fax: 612-725-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR033926
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: