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General NPI Number Information
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NPI Number | 1174668107
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Entity Type | Individual
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Provider Name | MIRANDA M PRAY-DEDE
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2820 MOUNT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701-5474
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Country | US
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Telephone | 605-342-3280
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Fax | 605-721-8458
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Provider Business Mailing Address
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Address Line | PO BOX 6020
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City | RAPID CITY
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State | SD
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Zip | 57709-6020
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Country | US
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Telephone | 605-956-0337
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Fax | 605-721-8458
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 32213
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 7570
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License Number State | SD
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