Individual
DR. MARYLOU MYLANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, RN, PMHNP
Contact information
Practice address
1011 11TH ST, RAPID CITY, SD 57701-3530
(605) 394-6617
(605) 394-1250
Mailing address
13716 GHOST CANYON RD, HERMOSA, SD 57744-5020
(605) 394-6617
(605) 394-1250
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R025102
SD
364SP0810X
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
R025102
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6575492
—
SD
Enumeration date
10/31/2007
Last updated
10/31/2007
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