Vicki Lynn Thaler, RN
Individual provider Active NPI Registered Nurse · Wagner, SD
NPI 1104033000 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1104033000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R019249 (SD)
- Practice address
- 111 Washington Ave NW
Wagner, SD 57380 - Phone
- (605) 384-3621
- Fax
- (605) 384-3293
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R019249 | SD | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R019249 | SD | Yes |
Addresses
Primary practice location
111 Washington Ave NW
Wagner, SD 57380
Mailing address
111 Washington Ave NW
Wagner, SD 57380
Phone (605) 384-3621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5540030 | Medicaid | SD | |
| 5540100 | Medicaid | SD |
Other providers in Wagner, SD
- Carol Lee Stewart
- David Dean Stimpson
- Mark Struble
- Timothy Darien Thaler
- Tori Sarah Thaler
- The Evangelical Lutheran Good Samaritan Society
- The Evangelical Lutheran Good Samaritan Society
- The Evangelical Lutheran Good Samaritan Society
- Jodi Jean Thompson
- TK Dispensing
All providers in Wagner, SD · Registered Nurse in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.