Individual
PELAGIE MCKENZIE JEWETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
24276 166TH STREET AIRPORT ROAD, EAGLE BUTTE, SD 57625
(605) 850-8813
Mailing address
24276 166TH STREET AIRPORT ROAD, EAGLE BUTTE, SD 57625
(605) 850-8813
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
A049898
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A049898
SD CERTIFIED NURSE AIDE
SD
Enumeration date
06/29/2020
Last updated
06/29/2020
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