Provider Demographics
NPI:1861058281
Name:NYATANGA, BRENDA T (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:NYATANGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 SUNNYBROOK DR STE L200
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4251
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:
Practice Address - Street 1:5885 SUNNYBROOK DR STE L200
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4251
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-53984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program