Healthcare Provider Details

I. General information

NPI: 1649505637
Provider Name (Legal Business Name): BRANDEE JO FLAGG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDEE JO SINKA RN

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601
US

IV. Provider business mailing address

100 E WAYNE ST STE 510
SOUTH BEND IN
46601-2394
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-5123
  • Fax: 574-282-2813
Mailing address:
  • Phone: 574-334-5390
  • Fax: 574-334-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003179A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: