Healthcare Provider Details

I. General information

NPI: 1932658762
Provider Name (Legal Business Name): LYNDSAY FARNSWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDSAY GRASS RN

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 HOMESTEAD ST
RAPID CITY SD
57703-0194
US

IV. Provider business mailing address

300 6TH ST
RAPID CITY SD
57701-5034
US

V. Phone/Fax

Practice location:
  • Phone: 605-393-2812
  • Fax: 605-393-2861
Mailing address:
  • Phone: 605-393-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberSD-RN R035810
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: