Individual
KENNETH R TRAVNICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 W GLYNN DR, PARKSTON, SD 57366-9605
(605) 928-3311
(605) 928-7368
Mailing address
401 W GLYNN DR, PARKSTON, SD 57366-9605
(605) 928-3311
(605) 928-7368
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CR000113
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4997801
WELLMARK BLUE CROSS BLUE SHIELD
SD
01
—
R014620
DAKOTACARE
SD
Enumeration date
08/11/2008
Last updated
08/11/2008
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