| Doctor Name: | MISS ELLEN PIETSCH |
| NPI Number: | 1184028383 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R042935 |
| Business Practice Address: | 24276 Airport Rd Eagle Butte, SD - 57625 |
| Business Phone Number: | 6059640705 |
| Business Fax Number: | |
| Mailing Address: | Po Box 882, EAGLE BUTTE |
| State: | SD |
| Postal Code: | 576250882 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2014 |
| NPI Last Update Date: | 10/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WM0705X |
| License Number: | R042935 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Medical-Surgical |
| Taxonomy Definition: | |