Individual
MS. DEANNA KAY MINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MLT(ASCP)
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2228
(605) 355-2514
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2228
(605) 355-2514
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
03496595
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140070
MEDICAID
SD
05
—
5549050
—
SD
Enumeration date
02/10/2010
Last updated
02/10/2010
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