Healthcare Provider Details

I. General information

NPI: 1659180131
Provider Name (Legal Business Name): RICHARD PAEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

408 S SHEBAL AVE
HARRISBURG SD
57032-2232
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax:
Mailing address:
  • Phone: 605-431-6537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberR035191
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: