Provider Demographics
NPI:1922241975
Name:RUES, BRENDA R (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:RUES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:R
Other - Last Name:ALFERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13100 E 136TH ST
Practice Address - Street 2:STE 1200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9418
Practice Address - Country:US
Practice Address - Phone:317-678-3100
Practice Address - Fax:317-678-3108
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28181996A363LA2200X
IN71002896A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201138290Medicaid
IN201138290Medicaid
IN264430092Medicare PIN