Doctor Name: | MS. ANGEL LEE WILSON |
NPI Number: | 1164430658 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | R024323 |
Business Practice Address: | Bia #1 Soldier Creek Rd Rosebud, SD - 57570 |
Business Phone Number: | 6057472231 |
Business Fax Number: | 6057472216 |
Mailing Address: | Po Box 1111, ROSEBUD |
State: | SD |
Postal Code: | 57570 |
Phone Number: | 6057475555 |
Fax Number: | |
NPI Enumeration Date: | 08/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R024323 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |