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NPI Code Detail

MEDICARE: LYNNE J LAIRD CNP

MEDICARE: LYNNE J LAIRD CNP
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
1207Q00000XFamily Medicine PhysicianR015451SD

General Provider Information

NPI Number : 1912941444
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNE J LAIRD CNP
Provider Business Mailing Address
First Line : 5410 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702
Country : US
Telephone Number : 605-348-4141
Fax Number : 605-342-7880
Provider Business Practice Location Address
First Line : 3810 JACKSON BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3246
Country : US
Telephone Number : 605-343-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 07/28/2010

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