MEDICARE: ALEEN M. GOLIS MS, APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CP000497	SD
2	363LF0000X	Family Nurse Practitioner		WY

General Provider Information

NPI Number	:	1225097199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEEN M. GOLIS MS, APRN, BC

Provider Business Mailing Address
First Line	:	2210 JENNINGS AVE
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1829
Country	:	US
Telephone Number	:	605-745-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N 5TH ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1480
Country	:	US
Telephone Number	:	605-745-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/16/2007

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