Healthcare Provider Details

I. General information

NPI: 1821576109
Provider Name (Legal Business Name): BRANDYN TAYLOR GARNER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 S PARNELL AVE
CHICAGO IL
60620-2240
US

IV. Provider business mailing address

9057 S PARNELL AVE
CHICAGO IL
60620-2240
US

V. Phone/Fax

Practice location:
  • Phone: 773-960-3024
  • Fax:
Mailing address:
  • Phone: 773-960-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043119150
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: