MEDICARE: AMANDA GLANZER

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	CP001121	SD

General Provider Information

NPI Number	:	1023565645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GLANZER

Provider Business Mailing Address
First Line	:	7701 W 65TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-8802
Country	:	US
Telephone Number	:	605-212-2883
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 W 65TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-8802
Country	:	US
Telephone Number	:	605-212-2883
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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Directions to “ AMANDA GLANZER ” Practice Location

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