Individual
HOLLY HUMPHRIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
EAST HIGHWAY 18, PINE RIDGE, SD 57770
(605) 867-3006
Mailing address
PO BOX 1201, PINE RIDGE, SD 57770-1201
(605) 867-3006
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
262299
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497786412
—
SD
Enumeration date
09/02/2016
Last updated
09/02/2016
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