Basic Information
| Provider Information | |||||||||
| NPI: | 1700365681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDENBURG | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 PARKSIDE DR SW | ||||||||
| Address2: | |||||||||
| City: | HURON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573508934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053506310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1508 W 22ND ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053283840 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2018 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CP001417 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.