Healthcare Provider Details

I. General information

NPI: 1730349267
Provider Name (Legal Business Name): JOSEPH WILLIAM LLITERAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST HWY 18
PINE RIDGE SD
57770
US

IV. Provider business mailing address

PO 1201 EAST HWY 18
PINE RIDGE SD
57770
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-5131
  • Fax: 605-867-3263
Mailing address:
  • Phone: 605-867-5131
  • Fax: 605-867-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number44131
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: