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General NPI Number Information
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NPI Number | 1073441697
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Entity Type | Organization
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Legal Business Name | RURAL ROOTS PRIVATE NURSING, PLLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 47169 US HIGHWAY 12
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City | TWIN BROOKS
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State | SD
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Zip | 57269-5805
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Country | US
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Telephone | 712-251-3796
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Fax |
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Provider Business Mailing Address
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Address Line | 47169 US HIGHWAY 12
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City | TWIN BROOKS
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State | SD
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Zip | 57269-5805
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Country | US
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Telephone | 712-251-3796
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JENNIFER TILLMA
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Credential | RN
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Telephone | 712-251-3796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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