Individual
MICHELLE RAE WANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6701 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2591
(605) 322-6960
(605) 322-6961
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2006012197
MO
207N00000X
Dermatology Physician
Primary
7571
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900570
—
SD
Enumeration date
08/30/2006
Last updated
10/15/2018
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