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General NPI Number Information
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NPI Number | 1346837002
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Entity Type | Individual
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Provider Name | ANASTACIA MARIE BRANDENBURG AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 14 TRAFALGAR SQ
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City | TRAFALGAR
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State | IN
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Zip | 46181-9515
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Country | US
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Telephone | 812-636-1343
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Fax | 812-526-4900
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Provider Business Mailing Address
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Address Line | 14 TRAFALGAR SQ
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City | TRAFALGAR
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State | IN
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Zip | 46181-9515
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Country | US
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Telephone | 812-636-1343
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Fax | 812-526-4900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 28093774A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 71012266A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 71012266A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 71012266A
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License Number State | IN
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