Individual
KATE EAGLESTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24276 166TH ST. AIRPORT RAOD, EAGLE BUTTE, SD 57625
(605) 964-7724
Mailing address
PO BOX 1012, EAGLE BUTTE, SD 57625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P010457
SD
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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