Provider Demographics
NPI:1518954817
Name:PENDO, ANITA A (CNP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:A
Last Name:PENDO
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 1:1120 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7718
Mailing Address - Country:US
Mailing Address - Phone:605-388-9328
Mailing Address - Fax:
Practice Address - Street 1:6511 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1286
Practice Address - Country:US
Practice Address - Phone:605-361-5100
Practice Address - Fax:605-361-9523
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD0324363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994609OtherWELLMARK INSURANCE