MEDICARE: BRANDI D THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		IL

General Provider Information

NPI Number	:	1508750597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI D THOMPSON

Provider Business Mailing Address
First Line	:	101 N 9TH ST
Second Line	:
City	:	DUPO
State	:	IL
Zip	:	62239-1515
Country	:	US
Telephone Number	:	618-670-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 SAINT JUSTIN DR
Second Line	:
City	:	CAHOKIA HEIGHTS
State	:	IL
Zip	:	62206-1625
Country	:	US
Telephone Number	:	618-670-8630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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