Provider Demographics
NPI:1467225458
Name:BARAGAR, DENISE MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:BARAGAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15574 LONESOME DOVE ST
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-8139
Mailing Address - Country:US
Mailing Address - Phone:605-415-6618
Mailing Address - Fax:
Practice Address - Street 1:241 MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6219
Practice Address - Country:US
Practice Address - Phone:605-791-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR050518163W00000X
SDCP003054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse