Individual
BRENDAN WICAKASOTA WHITEBIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN-BSN
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
R058640
SD
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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