Shannon Renee Brautigan, RN
Individual provider Active NPI Registered Nurse · Eagle Butte, SD
NPI 1730706706 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1730706706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R0063484 (OK)
- Practice address
- 24276 166TH Street Airport Rd.
Eagle Butte, SD 57625 - Phone
- (605) 964-7724
- NPI assigned
- Jun 25, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0063484 | OK | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R0063484 | OK | Yes |
Addresses
Primary practice location
24276 166TH Street Airport Rd.
Eagle Butte, SD 57625
Mailing address
24276 166TH Street, Airport Rd
Eagle Butte, SD 57625
Other providers in Eagle Butte, SD
- Susan F Baker
- Sarah Bennett
- Eduardo Alejandro Bilbao la Vieja
- Mark D Black
- Blackhills Dialysis, L.L.C.
- Elaine C Brehmer
- Lisa Marie Brower
- Valarie L Brown
- Linda Bruguier
- Heidi Brunk
All providers in Eagle Butte, SD · Registered Nurse in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.