Provider Demographics
NPI:1720298722
Name:MCGINNIS, CAROL MARIE (RN- CNS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:RN- CNS
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MARIE
Other - Last Name:LIBERKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4921
Mailing Address - Country:US
Mailing Address - Phone:650-338-2946
Mailing Address - Fax:605-333-4299
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-7132
Practice Address - Fax:605-333-4299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-CNS CS004005163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support