Provider Demographics
NPI:1407654551
Name:CRUZ, BRENDA ELAINE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELAINE
Last Name:CRUZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5273
Mailing Address - Country:US
Mailing Address - Phone:605-232-2800
Mailing Address - Fax:612-725-1097
Practice Address - Street 1:380 W ANCHOR DR
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-5273
Practice Address - Country:US
Practice Address - Phone:605-232-2800
Practice Address - Fax:612-725-1097
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP56068164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse