Individual
RANDI PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
317 MAIN STREET, EAGLE BUTTE, SD 57625-1012
(605) 964-3007
Mailing address
PO BOX 1115, EAGLE BUTTE, SD 57625-1115
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R035514
SD
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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