Healthcare Provider Details

I. General information

NPI: 1588326128
Provider Name (Legal Business Name): NICHOLAS GRANT CAIN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 07/01/2024
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MCKINNEY AVE
BENSON MN
56215-1638
US

IV. Provider business mailing address

2333 250TH ST
MADISON MN
56256-3001
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-2030
  • Fax:
Mailing address:
  • Phone: 301-885-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8830
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: