Healthcare Provider Details

I. General information

NPI: 1720298722
Provider Name (Legal Business Name): CAROL MARIE MCGINNIS RN- CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL MARIE LIBERKO

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

4301 S CLIFF AVE
SIOUX FALLS SD
57103-4921
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-7132
  • Fax: 605-333-4299
Mailing address:
  • Phone: 650-338-2946
  • Fax: 605-333-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberSD-CNS CS004005
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: