Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CP001410 | SD |
NPI | 1003393570 |
---|---|
Provider Name | Maria Sargent |
First Address | Rapid City, SD 57709-6000 |
Second Address | Rapid City, SD 57701-7375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 13/11/2020 |