Organization
SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISE JOHNSON (TRIBAL HEALTH DIRECTOR)
(605) 698-8315
Entity
Organization
Contact information
Practice address
12554 BIA HIGHWAY 711, AGENCY VILLAGE, SD 57262-7409
(605) 698-3911
Mailing address
PO BOX 509, AGENCY VILLAGE, SD 57262-0509
(605) 698-3911
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/23/2024
Last updated
09/23/2024
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