Healthcare Provider Details

I. General information

NPI: 1992515456
Provider Name (Legal Business Name): ANNA WYLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 10TH AVE SE
ABERDEEN SD
57401-8027
US

IV. Provider business mailing address

3307 10TH AVE SE
ABERDEEN SD
57401-8027
US

V. Phone/Fax

Practice location:
  • Phone: 605-229-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR034646
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: