Individual
MADISEN DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
24276 AIRPORT RD, EAGLE BUTTE, SD 57625-8021
(605) 645-0063
Mailing address
24276 AIRPORT RD, EAGLE BUTTE, SD 57625-8021
(605) 645-0063
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
R052076
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R052076
NURSE
SD
Enumeration date
05/27/2020
Last updated
05/27/2020
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