Individual
PAULINE A LARVIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
(605) 355-2512
Mailing address
3200 CANYON LAKE DR., RAPID CITY IHS HOSPITAL, RAPID CITY, SD 57702
(605) 335-2500
(605) 335-2512
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P010270
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0140070
—
SD
05
—
5549050
—
SD
Enumeration date
12/02/2011
Last updated
12/02/2011
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