Individual
MELLISSA JO VIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24276 AIRPORT RD. 166TH STREET, EAGLE BUTTE, SD 57626
(605) 964-7724
Mailing address
18138 OPAL RD, OPAL, SD 57758-7060
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
R036323
SD
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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