Healthcare Provider Details

I. General information

NPI: 1437046265
Provider Name (Legal Business Name): BLAKE RAE BARTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

IV. Provider business mailing address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

V. Phone/Fax

Practice location:
  • Phone: 605-884-2024
  • Fax: 612-725-1099
Mailing address:
  • Phone: 605-884-2420
  • Fax: 612-725-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR042068
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: