Provider Demographics
NPI:1689745176
Name:MCCAIN, BRENDA L (ANP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 E PALMER WASILLA HWY
Mailing Address - Street 2:SUITE 501 ADVANCED PAIN CENTER OF ALASKA
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7274
Mailing Address - Country:US
Mailing Address - Phone:907-357-8330
Mailing Address - Fax:
Practice Address - Street 1:3035 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE 501 ADVANCED PAIN CENTER OF ALASKA
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7274
Practice Address - Country:US
Practice Address - Phone:907-357-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9712163W00000X
AK717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP55962Medicaid
AKNP55962Medicaid