| Doctor Name: | GAIL SUE WILD |
| NPI Number: | 1629016480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 0204 |
| Business Practice Address: | 2200 13th Ave Belle Fourche, SD - 57717 |
| Business Phone Number: | 6058922701 |
| Business Fax Number: | 6056444197 |
| Mailing Address: | 353 Fairmont Blvd, Atten Medical Staff Services RAPID CITY |
| State: | SD |
| Postal Code: | 577016000 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2006 |
| NPI Last Update Date: | 01/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0204 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |