Healthcare Provider Details

I. General information

NPI: 1720323868
Provider Name (Legal Business Name): RHONDA K ENGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N 10TH ST
SPEARFISH SD
57783-1532
US

IV. Provider business mailing address

353 FAIRMONT BLVD ATTEN MSS
RAPID CITY SD
57701-7375
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-8414
  • Fax: 605-642-8618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000757
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: