Individual
CAROL E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1623 EVERGREEN DR, RAPID CITY, SD 57702-3454
(605) 484-7090
Mailing address
1623 EVERGREEN DR, RAPID CITY, SD 57702-3454
(605) 484-7090
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
R014517
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R014517
SD NURSING LICENSE
SD
Enumeration date
07/25/2018
Last updated
07/25/2018
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