Provider Demographics
NPI:1730916123
Name:CARL, BRANDI LYNN (RN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:CARL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E HONEYWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HOOPESTON
Mailing Address - State:IL
Mailing Address - Zip Code:60942-1411
Mailing Address - Country:US
Mailing Address - Phone:217-495-3090
Mailing Address - Fax:
Practice Address - Street 1:602 E HONEYWELL AVE
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1411
Practice Address - Country:US
Practice Address - Phone:217-495-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.459790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty