Healthcare Provider Details

I. General information

NPI: 1194551853
Provider Name (Legal Business Name): JESSICA MAE CAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 NW 7TH ST
BRAINERD MN
56401-2912
US

IV. Provider business mailing address

3694 ALPINE DR SW
PILLAGER MN
56473-2558
US

V. Phone/Fax

Practice location:
  • Phone: 218-825-2603
  • Fax: 612-725-1302
Mailing address:
  • Phone: 612-695-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR164968-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: