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General NPI Number Information
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NPI Number | 1124345103
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Entity Type | Individual
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Provider Name | KELSEY RAYE NYLANDER D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 1420 N 10TH ST
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City | SPEARFISH
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State | SD
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Zip | 57783
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Country | US
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Telephone | 605-717-8595
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Fax | 605-642-8618
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Provider Business Mailing Address
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Address Line | 1420 N 10TH ST
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City | SPEARFISH
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State | SD
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Zip | 57783-1532
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Country | US
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Telephone | 605-717-8595
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Fax | 605-642-8618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 54737
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License Number State | MN
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