# SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION
- **Other names:** SISSETON-WAHPETON OYATE ASNIYAPI FIELD HEALTH CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629858519
- **Legal business name:** SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION
- **Authorized official:** ELISE JOHNSON MPH (SWO TRIBAL HEALTH DIRECTOR)
- **Authorized official phone:** (605) 698-8315

## Contact information

- **Practice address:** 114 LAKE TRAVERSE DR STE 102, SISSETON, SD 57262-7046
- **Practice address phone:** (833) 674-3444
- **Practice address fax:** (605) 303-5295
- **Mailing address:** PO BOX 509, SISSETON, SD 57262-0509
- **Mailing address phone:** (605) 742-3697
- **Mailing address fax:** (605) 698-4239

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/29/2023
- **Last updated:** 02/22/2024