Provider Demographics
NPI:1346297009
Name:SEARS, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 SHERIDAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9208
Mailing Address - Country:US
Mailing Address - Phone:605-348-4141
Mailing Address - Fax:605-342-7880
Practice Address - Street 1:5410 SHERIDAN LAKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9208
Practice Address - Country:US
Practice Address - Phone:605-348-4141
Practice Address - Fax:605-342-7880
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00262773OtherRR MEDICARE
SD4994364OtherBCBS
SD5611810Medicaid
SDI43052Medicare UPIN
SD4994364OtherBCBS
SDP00262773OtherRR MEDICARE