Healthcare Provider Details

I. General information

NPI: 1902733223
Provider Name (Legal Business Name): BRANDI BROWN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CENTRAL SCHOOL RD
BELLEVILLE IL
62220-3265
US

IV. Provider business mailing address

1801 CENTRAL SCHOOL RD
BELLEVILLE IL
62220-3265
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-5377
  • Fax: 618-233-5377
Mailing address:
  • Phone: 618-233-5377
  • Fax: 618-233-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043132373
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2025009504
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: