Provider Demographics
NPI:1336183995
Name:RANEK, LORI (PA-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:RANEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BON HOMME FAMILY PRACTICE
Mailing Address - Street 2:410 W 16TH AVE
Mailing Address - City:TYNDALL
Mailing Address - State:SD
Mailing Address - Zip Code:57066
Mailing Address - Country:US
Mailing Address - Phone:605-589-2190
Mailing Address - Fax:605-589-2115
Practice Address - Street 1:410 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2318
Practice Address - Country:US
Practice Address - Phone:605-589-4602
Practice Address - Fax:605-589-3288
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1044OtherDAKOTACARE
SD4996773OtherBCBS
SD6825990Medicaid
SD4996773OtherBCBS
SD6825990Medicaid