Individual
BRANDON STUART BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1000 N WESTMORELAND RD, LAKE FOREST, IL 60045-1658
(847) 234-5600
Mailing address
415 W ALDINE AVE APT 2C, CHICAGO, IL 60657-3601
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209020242
IL
364SE0003X
Emergency Clinical Nurse Specialist
209020242
IL
Other
Enumeration date
12/05/2019
Last updated
04/15/2020
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