Individual
SUSAN JEAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
E HWY 18, PINE RIDGE, SD 57770-1201
(605) 867-5131
(605) 867-3263
Mailing address
E HWY 18, PINE RIDGE, SD 57770-1201
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26784
NE
Other
Enumeration date
06/16/2008
Last updated
06/16/2008
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