Provider Demographics
NPI:1760601587
Name:LAMMERS, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LAMMERS
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:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:HANA
Mailing Address - State:HI
Mailing Address - Zip Code:96713-0156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 ELK ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7351
Practice Address - Country:US
Practice Address - Phone:605-343-7262
Practice Address - Fax:605-343-7293
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD35363LP0808X
CA53253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4997127OtherBLUE CROSS/BLUE SHIELD
SD4997140OtherBLUE CROSS/BLUE SHIELD
SD4997140OtherBLUE CROSS/BLUE SHIELD
SD4997127OtherBLUE CROSS/BLUE SHIELD
SDS100312Medicare PIN
SDS40323Medicare PIN