Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 4737 | SD |
NPI | 1164479630 |
---|---|
Provider Name | Rachel C Edelen |
First Address | Rapid City, SD 57701-6000 |
Second Address | Rapid City, SD 57701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34043 | (02) |