Individual
LI REN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
640 FLORMANN ST, RAPID CITY, SD 57701
(605) 718-3300
(605) 718-3426
Mailing address
353 FAIRMONT BLVD, ATTEN MEDICAL STAFF SERVICES, RAPID CITY, SD 57701-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0622
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00360757
RR MEDICARE
SD
Enumeration date
07/18/2006
Last updated
01/24/2013
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