MEDICARE: MARIAH JENNIFER RATLIFF LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PO15050	SD

General Provider Information

NPI Number	:	1417800038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH JENNIFER RATLIFF LPN

Provider Business Mailing Address
First Line	:	2305 LOCKWOOD DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 LOCKWOOD DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4267
Country	:	US
Telephone Number	:	605-343-7262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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