Provider Demographics
NPI:1942537741
Name:LABONTE, KATHERINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:LABONTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:LABONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3200 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8114
Mailing Address - Country:US
Mailing Address - Phone:605-355-2206
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-355-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR16231163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549050Medicaid
SD0140070Medicaid
SDPHS000Medicare UPIN
SD0140070Medicaid
SD430082Medicare Oscar/Certification