Basic Information
| Provider Information | |||||||||
| NPI: | 1821012014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 PENNY AVE | ||||||||
| Address2: | |||||||||
| City: | EAST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601181454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478367015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 E BRUSH HILL RD | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312211000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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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 | 367500000X | 041270105 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.