Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CP000603 | SD |
NPI | 1013222157 |
---|---|
Provider Name | Jennifer Ann Erdman |
First Address | Rapid City, SD 57701-4694 |
Second Address | Rapid City, SD 57701-4694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 27/08/2015 |