Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | CP001551 | SD |
NPI | 1538629753 |
---|---|
Provider Name | Steven L Dary |
First Address | Rapid City, SD 57701-1669 |
Second Address | Rapid City, SD 57701-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2019 |
Last Update Date | 22/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018077484 | ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER (AGPCNP-BC) (01) |