Individual
JAESHAUN RENVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 LAKE TRAVERSE DR, SISSETON, SD 57262-7046
(605) 698-7606
(605) 742-0182
Mailing address
20 7TH AVE W, SISSETON, SD 57262-1753
(605) 268-2331
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P011701
SD
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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