Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 10377 | SD |
N | 208000000X | Pediatrician | 60086-20 | WI |
NPI | 1659669984 |
---|---|
Provider Name | Halie M Anderson |
First Address | Rapid City, SD 57709-6020 |
Second Address | Rapid City, SD 57701-5462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 16/02/2018 |