Individual
MRS. LISA GENNARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 MADILL ST, KEYSTONE, SD 57751-2075
(605) 666-4149
Mailing address
1305 MADILL ST, KEYSTONE, SD 57751-2075
(605) 666-4149
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
—
—
251E00000X
Home Health Agency
Primary
—
SD
332B00000X
Durable Medical Equipment & Medical Supplies
—
SD
374U00000X
Home Health Aide
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9551220
—
SD
Enumeration date
02/07/2019
Last updated
11/03/2025
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