Provider Demographics
NPI:1790468874
Name:PURTELL, LANNESE DEANN (CNP)
Entity Type:Individual
Prefix:
First Name:LANNESE
Middle Name:DEANN
Last Name:PURTELL
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 1:23085 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-9027
Mailing Address - Country:US
Mailing Address - Phone:605-391-7834
Mailing Address - Fax:
Practice Address - Street 1:717 SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4677
Practice Address - Country:US
Practice Address - Phone:605-342-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily