Basic Information
| Provider Information | |||||||||
| NPI: | 1487197588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | TEAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4822 CATON FARM RD | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605868262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003238622 | ||||||||
| FaxNumber: | 2242250355 | ||||||||
| Practice Location | |||||||||
| Address1: | 954 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | SYCAMORE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601781335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158959144 | ||||||||
| FaxNumber: | 8158955740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2016 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209014996 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.