Individual
BRANDON ROBERT MCNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 BLUEBIRD DR, GOODLETTSVILLE, TN 37072-2301
(615) 859-7546
Mailing address
820 SPRINGER DR, LOMBARD, IL 60148-6413
(815) 744-8554
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/10/2015
Last updated
04/03/2023
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