Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 12106 | SD |
NPI | 1003349903 |
---|---|
Provider Name | Kimberly Hushagen |
First Address | Rapid City, SD 57701-7316 |
Second Address | Rapid City, SD 57701-7316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 14/09/2020 |