Basic Information
| Provider Information | |||||||||
| NPI: | 1598788705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HOLLISTER DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Practice Location | |||||||||
| Address1: | 27750 W IL ROUTE 22 | ||||||||
| Address2: | SUITE G80 | ||||||||
| City: | BARRINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600102379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.