Individual
MISS GEORGIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
601 GALL ST., LOWER BRULE, SD 57548
(605) 473-8243
(605) 473-0607
Mailing address
P.O. BOX 187, LOWER BRULE, SD 57548
(605) 473-8243
(605) 473-0607
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P011717
SD
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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