Healthcare Provider Details

I. General information

NPI: 1972961324
Provider Name (Legal Business Name): MELISSA ANNE TRAUB CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANNE BASHAM

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 FLORMANN ST
RAPID CITY SD
57701-4679
US

IV. Provider business mailing address

640 FLORMANN ST
RAPID CITY SD
57701-4679
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-3300
  • Fax:
Mailing address:
  • Phone: 605-755-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001038
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: