Healthcare Provider Details

I. General information

NPI: 1821808775
Provider Name (Legal Business Name): GINA WUBBEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA LUDENS RN

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

IV. Provider business mailing address

6312 W 53RD ST
SIOUX FALLS SD
57106-1920
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax: 605-977-4406
Mailing address:
  • Phone: 605-661-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR045506
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: