Individual
REBECCA L STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 755-8222
(605) 755-4203
Mailing address
PO BOX 912882, DENVER, CO 80291-2882
(866) 765-0909
(855) 856-8520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0792
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1471560
—
ND
05
—
1578884847
—
CO
05
—
1578884847
—
SD
05
—
1578884847
—
WY
Enumeration date
06/21/2010
Last updated
03/04/2019
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