Provider Demographics
NPI:1649505637
Name:FLAGG, BRANDEE JO (NP)
Entity type:Individual
Prefix:
First Name:BRANDEE
Middle Name:JO
Last Name:FLAGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDEE
Other - Middle Name:JO
Other - Last Name:SINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 E WAYNE ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2394
Mailing Address - Country:US
Mailing Address - Phone:574-334-5390
Mailing Address - Fax:574-334-5368
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-234-5123
Practice Address - Fax:574-282-2813
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003179A363L00000X
IN28140835A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200973990Medicaid
IN000000646392OtherANTHEM