Provider Information for 1396287520
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WILLETTA WOODSON ACT
Sex: Female
NPI: 1396287520
Last Updated: 2024-04-04
Certification Date: 2024-04-04
Certification Date: 2024-04-04
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1396287520 | ||||||||||||
| Enumeration Date | 2016-11-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3013 OUTLOOK CIR UNIT B RAPID CITY, SD 57701-5919 United States Phone: 605-593-1652 | Fax: | ||||||||||||
| Primary Practice Address | 350 ELK ST RAPID CITY, SD 57701-7351 United States Phone: 605-343-7262 | Fax: | ||||||||||||
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