Healthcare Provider Details

I. General information

NPI: 1811015449
Provider Name (Legal Business Name): DEBORAH JEANNETTE KNISPEL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH JEANNETTE SCHWAB LICENSE PRACTICAL NU

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

25586 SOUTH DAKOTA HWY 44
WHITE RIVER SD
57579
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-3245
  • Fax: 605-747-5348
Mailing address:
  • Phone: 605-259-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53860
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: