Healthcare Provider Details

I. General information

NPI: 1467123448
Provider Name (Legal Business Name): PAMELA DIANE BRANTLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 RING RD
CALUMET CITY IL
60409-5459
US

IV. Provider business mailing address

1473 RING RD
CALUMET CITY IL
60409-5459
US

V. Phone/Fax

Practice location:
  • Phone: 708-862-8156
  • Fax:
Mailing address:
  • Phone: 847-845-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: