Provider Demographics
NPI:1346837002
Name:BRANDENBURG, ANASTACIA MARIE (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:MARIE
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:ANASTACIA
Other - Middle Name:MARIE
Other - Last Name:SORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AG-CNS-BC
Mailing Address - Street 1:14 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9515
Mailing Address - Country:US
Mailing Address - Phone:812-636-1343
Mailing Address - Fax:812-526-4900
Practice Address - Street 1:14 TRAFALGAR SQ
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181-9515
Practice Address - Country:US
Practice Address - Phone:812-636-1343
Practice Address - Fax:812-526-4900
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28093774A163WG0000X
IN71012266A364S00000X, 364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health