Healthcare Provider Details

I. General information

NPI: 1295014926
Provider Name (Legal Business Name): MRS. NATALIE JENEAN BRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3362 BIG PINE TRL STE A
CHAMPAIGN IL
61822-1409
US

IV. Provider business mailing address

3362 BIG PINE TRL STE A
CHAMPAIGN IL
61822-1409
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-0151
  • Fax: 217-633-4555
Mailing address:
  • Phone: 217-383-0151
  • Fax: 217-633-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.118431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: