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NPI Code Detail

MEDICARE: LISA KAUTZMAN CNP RN

MEDICARE: LISA KAUTZMAN CNP RN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0241SD

General Provider Information

NPI Number : 1861462194
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KAUTZMAN CNP RN
Provider Business Mailing Address
First Line : 350 ELK ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7351
Country : US
Telephone Number : 605-343-7262
Fax Number : 605-343-7293
Provider Business Practice Location Address
First Line : 350 ELK ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7351
Country : US
Telephone Number : 605-343-7262
Fax Number : 605-343-7293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 08/30/2011

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