MEDICARE: NANCY L WILSON M.D.

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	2084P0800X	Psychiatry Physician	1225	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	241638	OTHER	SD	MIDLANDS CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9217282	OTHER	SD	DAKOTACARE
4	HP40082	OTHER	SD	HEALTHPARTNERS
5	040121002	OTHER	MN	PRIMEWEST
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	235562	OTHER	SD	ARAZ/ AMERICA'S PPO
8	478R1WI	OTHER	MN	CC SYSTEMS/ BLUE PLUS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	412991012874	OTHER	SD	PREFERRED ONE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	57108C029	OTHER	SD	WPS TRICARE
13	370624200	OTHER	SD	DEPT OF LABOR
14	4994862	OTHER	SD	BLUE CROSS
15	30853	OTHER	SD	SANFORD HEALTH PLAN
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639142185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY L WILSON M.D.

Provider Business Mailing Address
First Line	:	2400 S. MINNESOTA AVE
Second Line	:	STE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-3762
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	4400 W 69TH ST
Second Line	:	STE 1500
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8170
Country	:	US
Telephone Number	:	605-322-5700
Fax Number	:	605-322-5704

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	12/11/2013

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