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NPI Code Detail

MEDICARE: SABRENA L ANDERSON PA-C

MEDICARE: SABRENA L ANDERSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant3497AZ

General Provider Information

NPI Number : 1619060266
Entity Type Code : Individual
Provider Name (Legal Business Name) : SABRENA L ANDERSON PA-C
Provider Business Mailing Address
First Line : 21678 MCINTOSH RD
Second Line :
City : PIEDMONT
State : SD
Zip : 57769-2127
Country : US
Telephone Number : 480-694-2419
Fax Number :
Provider Business Practice Location Address
First Line : 2165 PROMISE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-8981
Country : US
Telephone Number : 605-718-1095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 03/18/2024

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Directions to “ SABRENA L ANDERSON PA-C” Practice Location

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