Individual
WANDA JEAN DALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
111 WASHINGTON AVE NW, WAGNER, SD 57380
(605) 384-3621
(605) 384-3293
Mailing address
111 WASHINGTON AVE NW, WAGNER, SD 57380
(605) 384-3621
(605) 384-3293
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
185598
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5540030
—
SD
05
—
5540100
—
SD
Enumeration date
05/17/2007
Last updated
07/09/2007
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