Healthcare Provider Details

I. General information

NPI: 1366592180
Provider Name (Legal Business Name): MARK A BRAMBLETT REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOLDIER CREEK ROAD ROSEBUD IHS HOSPITAL
ROSEBUD SD
57570
US

IV. Provider business mailing address

SOLDIER CREEK ROAD ROSEBUD IHS HOSPITAL
ROSEBUD SD
57570
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-2231
  • Fax: 605-747-2216
Mailing address:
  • Phone: 605-747-2231
  • Fax: 605-747-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number20823
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: