Basic Information
| Provider Information | |||||||||
| NPI: | 1578979845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOVACH | ||||||||
| FirstName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10 | ||||||||
| Address2: | |||||||||
| City: | WANBLEE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575770010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515339430 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 1 ST STREET | ||||||||
| Address2: | |||||||||
| City: | WANBLEE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054626155 | ||||||||
| FaxNumber: | 6054626631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 716638 | CA | Y | Nursing Service Providers | Registered Nurse | 163WG0000X | 716638 | CA | N | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.