Provider Demographics
NPI:1912516832
Name:WISE, ERRIN JOY (MS, RD)
Entity type:Individual
Prefix:
First Name:ERRIN
Middle Name:JOY
Last Name:WISE
Suffix:
Gender:
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3399
Mailing Address - Country:US
Mailing Address - Phone:605-499-9190
Mailing Address - Fax:
Practice Address - Street 1:3645 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3399
Practice Address - Country:US
Practice Address - Phone:605-385-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered