Healthcare Provider Details

I. General information

NPI: 1184616658
Provider Name (Legal Business Name): BRANDI NICOLE STRAIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E MAIN CROSS ST
EDINBURGH IN
46124-1501
US

IV. Provider business mailing address

4677 WATERS EDGE WAY
GREENWOOD IN
46143-7814
US

V. Phone/Fax

Practice location:
  • Phone: 812-526-9999
  • Fax: 812-526-4900
Mailing address:
  • Phone: 317-422-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001807A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: