Provider Demographics
NPI:1043945587
Name:NEZ, PRISCILLA ANN
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:NEZ
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 1:321 KANSAS CITY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3086
Mailing Address - Country:US
Mailing Address - Phone:605-391-4863
Mailing Address - Fax:605-791-0434
Practice Address - Street 1:321 KANSAS CITY ST STE 120
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3086
Practice Address - Country:US
Practice Address - Phone:605-391-4863
Practice Address - Fax:605-791-0434
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator