Provider Demographics
NPI:1588326128
Name:CAIN, NICHOLAS GRANT (CNP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GRANT
Last Name:CAIN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 250TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256-3001
Mailing Address - Country:US
Mailing Address - Phone:301-885-8249
Mailing Address - Fax:
Practice Address - Street 1:1810 MCKINNEY AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1638
Practice Address - Country:US
Practice Address - Phone:320-843-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily