| Doctor Name: | WANDA JEAN DALLY |
| NPI Number: | 1740497775 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MT |
| License Number: | 185598 |
| Business Practice Address: | 111 Washington Ave Nw Wagner, SD - 57380 |
| Business Phone Number: | 6053843621 |
| Business Fax Number: | 6053843293 |
| Mailing Address: | 111 Washington Ave Nw, WAGNER |
| State: | SD |
| Postal Code: | 57380 |
| Phone Number: | 6053843621 |
| Fax Number: | 6053843293 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | 185598 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |