Healthcare Provider Details

I. General information

NPI: 1750782736
Provider Name (Legal Business Name): BRENDA SUE SIOLO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 EDGEWATER DR
SAVAGE MN
55378-5616
US

IV. Provider business mailing address

1301 BERTHA HOWE AVE. STE.1
MESQUITE NV
89027-7567
US

V. Phone/Fax

Practice location:
  • Phone: 612-558-0066
  • Fax:
Mailing address:
  • Phone: 702-346-0800
  • Fax: 702-346-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: