Healthcare Provider Details

I. General information

NPI: 1235841487
Provider Name (Legal Business Name): DANIEL ANTHONY ZIMBARDO BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CANYON LAKE DR
RAPID CITY SD
57702-8114
US

IV. Provider business mailing address

3518 BROOKSIDE DR
RAPID CITY SD
57702-2211
US

V. Phone/Fax

Practice location:
  • Phone: 605-355-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR046685
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: