Individual
BRANDI ITHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(630) 391-0962
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
041430200
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
209023222
IL
Other
Enumeration date
01/01/2021
Last updated
06/03/2022
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