MEDICARE: BRENDA LE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	10004723A	IN

General Provider Information

NPI Number	:	1851102370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LE PA-C

Provider Business Mailing Address
First Line	:	430 N PARK AVE APT 312
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3678
Country	:	US
Telephone Number	:	217-840-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 N PARK AVE APT 312
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3678
Country	:	US
Telephone Number	:	217-840-7417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	06/18/2025

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Directions to “ BRENDA LE PA-C” Practice Location

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