Healthcare Provider Details

I. General information

NPI: 1164430658
Provider Name (Legal Business Name): ANGEL LEE WILSON-CROWE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24276 166TH ST
EAGLE BUTTE SD
57625-8141
US

IV. Provider business mailing address

24276 166TH ST
EAGLE BUTTE SD
57625-8141
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-0675
  • Fax:
Mailing address:
  • Phone: 605-964-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR024323
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: