NPI 1710201553

Ivan Vicente, IDMT

Practitioner Independent Duty Medical Technicians Ellsworth Afb, SD

Practice location

Address: 433 Black Elk CT, Ellsworth Afb, SD 57706-1847
Phone: (605) 521-3502

Registered specialties

Independent Duty Medical Technicians Primary

Other Service Providers Taxonomy 1710I1003X

Other Military Health Care Provider providers in South Dakota →

Registry record

NPI: 1710201553
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Mar 2010
Record last updated: 23 Mar 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.