Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4569 | SD |
N | 207PE0004X | Emergency Medical Services | 4569 | SD |
N | 207R00000X | Internist | 4569 | SD |
N | 111NI0900X | Internist | 4569 | SD |
NPI | 1134165442 |
---|---|
Provider Name | Rossitza T Vakarelska |
First Address | Cheyenne, WY 82009-7365 |
Second Address | Sioux Falls, SD 57108-8148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1564914 | (05) | IA |
346793700 | (05) | MN |
4569 | DAKOTA CARE (01) | SD |
4994203 | BCBS (01) | SD |
6004006 | (05) | SD |
H02588 | (02) | SD |