Healthcare Provider Details

I. General information

NPI: 1477289288
Provider Name (Legal Business Name): BRANDI A RUGEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI A BROCK

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-0980
  • Fax: 317-962-1221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003725A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: