Provider Demographics
NPI:1740574227
Name:ANTONIE, TORIE KAY (RN, BNS)
Entity Type:Individual
Prefix:
First Name:TORIE
Middle Name:KAY
Last Name:ANTONIE
Suffix:
Gender:F
Credentials:RN, BNS
Other - Prefix:
Other - First Name:TORIE
Other - Middle Name:KAY
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 SOUTH HARRISON AVE.
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-933-1430
Mailing Address - Fax:
Practice Address - Street 1:317 MAIN STEET
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625
Practice Address - Country:US
Practice Address - Phone:605-964-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR037629163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse