Healthcare Provider Details

I. General information

NPI: 1699495705
Provider Name (Legal Business Name): LEE BRATTAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3678 WALDEN PL
CARMEL IN
46033-4324
US

IV. Provider business mailing address

3678 WALDEN PL
CARMEL IN
46033-4324
US

V. Phone/Fax

Practice location:
  • Phone: 765-967-0070
  • Fax:
Mailing address:
  • Phone: 765-967-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28222124A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: