Individual
WETU WANAHCA LOCUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
EAST HWY 18, 1201, PINE RIDGE, SD 57770
(605) 867-5131
Mailing address
PO BOX 165, 3 MOCCASIN PARK, PINE RIDGE, SD 57770-0165
(605) 441-0544
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R040696
SD
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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