Provider Demographics
NPI:1225097199
Name:GOLIS, ALEEN M (MS, APRN, BC)
Entity Type:Individual
Prefix:
First Name:ALEEN
Middle Name:M
Last Name:GOLIS
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:ALEEN
Other - Middle Name:M
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2210 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1829
Mailing Address - Country:US
Mailing Address - Phone:605-745-2000
Mailing Address - Fax:
Practice Address - Street 1:500 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1480
Practice Address - Country:US
Practice Address - Phone:605-745-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000497363LF0000X
WY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily