Individual
MRS. TRACEY SHILMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED PRACTICAL N
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2351
Mailing address
2345 E SAINT FRANCIS ST, RAPID CITY, SD 57703-5968
(605) 545-7839
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P012400
SD
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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