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General NPI Number Information
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NPI Number | 1467266320
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Entity Type | Individual
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Provider Name | STACY A OTT RN
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 3200 CANYON LAKE DR
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City | RAPID CITY
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State | SD
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Zip | 57702-8114
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Country | US
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Telephone | 605-355-2500
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Fax | 605-355-2500
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Provider Business Mailing Address
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Address Line | 678 YOSEMITE WAY
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City | WHITEWOOD
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State | SD
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Zip | 57793-3101
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Country | US
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Telephone | 605-641-6978
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | SD-RNR058496
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License Number State | SD
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