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Individual

SUSAN A MATTHEW

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
7236 JORDAN DRIVE SUITE 101, RAPID CITY, SD 57701
(605) 341-5565
(605) 341-5595
Mailing address
7236 JORDAN DRIVE SUITE 101, PO BOX 6540, RAPID CITY, SD 57709-6540
(605) 341-5565
(605) 341-5595

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0284
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0040887
WELLMARK BCBS NUMBER
SD
01
311949
WY BCBS NUMBER
WY
05
6824580
SD
Enumeration date
02/07/2006
Last updated
07/09/2007
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