Healthcare Provider Details

I. General information

NPI: 1730713074
Provider Name (Legal Business Name): TERESA OLIVE OHLMACHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

IV. Provider business mailing address

216 KIM DR
LAFAYETTE LA
70503-3926
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-7106
  • Fax: 605-755-0707
Mailing address:
  • Phone: 563-505-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR001040
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: