Healthcare Provider Details

I. General information

NPI: 1699928044
Provider Name (Legal Business Name): BRENDA NEISS NURSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E HWY 18
PINE RIDGE SD
57770-1201
US

IV. Provider business mailing address

PO BOX 1201
PINE RIDGE SD
57770-1201
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-3099
  • Fax: 605-867-3097
Mailing address:
  • Phone: 605-867-3099
  • Fax: 605-867-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR033200
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: