1730342304 NPI number — MS. DEENA ELAINE ROSARIO RDH

Table of content: MS. DEENA ELAINE ROSARIO RDH (NPI 1730342304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730342304 NPI number — MS. DEENA ELAINE ROSARIO RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSARIO
Provider First Name:
DEENA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730342304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HEALTH CENTER ROAD KYLE HEALTH CENTER 57752
Provider Second Line Business Mailing Address:
PO BOX 540
Provider Business Mailing Address City Name:
KYLE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57752-0540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-455-8205
Provider Business Mailing Address Fax Number:
605-455-1289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HEALTH CENTER ROAD KYLE HEALTH CENTER 57752
Provider Second Line Business Practice Location Address:
#540
Provider Business Practice Location Address City Name:
KYLE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57752-0540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-455-8205
Provider Business Practice Location Address Fax Number:
605-455-1289
Provider Enumeration Date:
07/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  954 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)