Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
363LP2300X | 50 | Nurse Practitioner | |
Dietitian, Registered |
133V00000X | 71 | Registered Dietitian or Nutrition Professional |
| NPI # | 1629858519 |
| LBN Legal business name | SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION |
| Authorized official | ELISE JOHNSON - (SWO TRIBAL HEALTH DIRECTOR) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 09/29/2023 |
| Last updated | 02/22/2024 - About 2 years ago |
| Identifiers | n/a |
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