Basic Information
| Provider Information | |||||||||
| NPI: | 1649417072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SISSETON WAHPETON HEALTH CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | SISSETON WAHPETON HEALTH CARE CENTER | ||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2009 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | BIRNEY | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | LEAH | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE/AMBULATORY CARE | ||||||||
| AuthorizedOfficialTelephone: | 6056987606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN NURSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | RO28333 | SD | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.