Individual
MARY ANN MARRS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
7220 S HIGHWAY 16, RAPID CITY, SD 57702-8708
(605) 341-1414
(605) 341-7062
Mailing address
7220 S HIGHWAY 16, PO BOX 6850, RAPID CITY, SD 57702-8708
(605) 341-1414
(605) 341-7062
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R029403
SD
364S00000X
Clinical Nurse Specialist
Primary
SD-CNP CP000412
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1254560001
CIGNA MEDICARE
SD
05
—
6827452
—
SD
01
—
P00427538
MEDICARE RAILROAD PTAN
—
Enumeration date
11/10/2005
Last updated
12/06/2012
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