Individual
JORDAN LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
312 MAIN ST., EAGLE BUTTE, SD 57625
(605) 964-7724
Mailing address
312 MAIN ST., EAGLE BUTTE, SD 57625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R044810
SD
Other
Enumeration date
01/19/2012
Last updated
01/19/2012
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