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Individual

LISA ANN PENTECOST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 719-8382
(605) 719-4934
Mailing address
PO BOX 3450, RAPID CITY, SD 57709-3450
(605) 719-8382
(605) 719-4934

Taxonomy

Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
0137
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0137
CNP LICENSE
SD
01
4993198
WELLMARK
SD
05
6829780
SD
01
R025334
RN LICENSE
SD
Enumeration date
04/07/2007
Last updated
02/16/2008
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