Healthcare Provider Details

I. General information

NPI: 1023565645
Provider Name (Legal Business Name): AMANDA GLANZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W 65TH ST
SIOUX FALLS SD
57106-8802
US

IV. Provider business mailing address

7701 W 65TH ST
SIOUX FALLS SD
57106-8802
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-2883
  • Fax:
Mailing address:
  • Phone: 605-212-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001121
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: