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General NPI Number Information
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NPI Number | 1700365681
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Entity Type | Individual
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Provider Name | SAMANTHA RAE BRANDENBURG NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1508 W 22ND ST STE 101
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1514
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Country | US
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Telephone | 605-328-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 1095 PARKSIDE DR SW
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City | HURON
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State | SD
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Zip | 57350-8934
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Country | US
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Telephone | 605-350-6310
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CP001417
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License Number State | SD
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