Basic Information
| Provider Information | |||||||||
| NPI: | 1285110486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | ROSS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49 | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575550049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058562295 | ||||||||
| FaxNumber: | 8664236811 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 S. MAIN | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058562295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2018 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP001401 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.