Provider Demographics
NPI:1639142185
Name:WILSON, NANCY L (MD)
Entity Type:Individual
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First Name:NANCY
Middle Name:L
Last Name:WILSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2400 S. MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-12-11
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Provider Licenses
StateLicense IDTaxonomies
SD12252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD241638OtherMIDLANDS CHOICE
SD7101810Medicaid
SD9217282OtherDAKOTACARE
SDHP40082OtherHEALTHPARTNERS
MN040121002OtherPRIMEWEST
ND12200Medicaid
SD235562OtherARAZ/ AMERICA'S PPO
MN478R1WIOtherCC SYSTEMS/ BLUE PLUS
IA1999862Medicaid
SD412991012874OtherPREFERRED ONE
NE46022474352Medicaid
SD57108C029OtherWPS TRICARE
SD370624200OtherDEPT OF LABOR
SD4994862OtherBLUE CROSS
SD30853OtherSANFORD HEALTH PLAN
MN410862100Medicaid
SD57108C029OtherWPS TRICARE
NE46022474352Medicaid