Individual
JOANNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2333
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2333
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
SD-RN R029513
SD
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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