Healthcare Provider Details

I. General information

NPI: 1184214892
Provider Name (Legal Business Name): BRENDA CAIN RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5519 E 82ND ST STE D
INDIANAPOLIS IN
46250-4516
US

IV. Provider business mailing address

9842 HERALD SQ
FISHERS IN
46038-8852
US

V. Phone/Fax

Practice location:
  • Phone: 317-436-8133
  • Fax: 317-863-1413
Mailing address:
  • Phone: 317-435-8097
  • Fax: 317-863-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number28225472A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: