Individual
JEREMY COLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2333
(605) 355-2553
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2333
(605) 355-2553
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R042554
SD
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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