Provider Demographics
NPI:1285710616
Name:ANDERSEN, BRENDA FERN (CNP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:FERN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2643
Mailing Address - Country:US
Mailing Address - Phone:605-697-5106
Mailing Address - Fax:
Practice Address - Street 1:SDSU STUDENT HEALTH CLINIC
Practice Address - Street 2:N. CAMPUS DRIVE
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57007-0001
Practice Address - Country:US
Practice Address - Phone:605-688-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily