MEDICARE: RAPID CITY HEALTH PROFESSIONALS LLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1568234813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID CITY HEALTH PROFESSIONALS LLC

Provider Business Mailing Address
First Line	:	3939 CANYON LAKE DR STE B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0827
Country	:	US
Telephone Number	:	605-716-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 CANYON LAKE DR STE B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0827
Country	:	US
Telephone Number	:	605-716-3555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE DELZER
Credential	:	CNP
Telephone Number	:	605-209-6222

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	07/18/2024

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Directions to “RAPID CITY HEALTH PROFESSIONALS LLC ” Practice Location

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