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General NPI Number Information
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NPI Number | 1669847067
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Entity Type | Individual
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Provider Name | BRENDA LYNN VANDEWATER
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 1201 HIGHWAY 71 S
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City | HOT SPRINGS
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State | SD
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Zip | 57747-8800
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Country | US
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Telephone | 605-745-8910
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Fax | 605-745-7654
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Provider Business Mailing Address
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Address Line | 12349 ERSKINE RD
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City | HOT SPRINGS
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State | SD
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Zip | 57747-7508
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Country | US
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Telephone | 605-745-8910
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Fax | 605-745-7654
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP001015
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License Number State | SD
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