Healthcare Provider Details

I. General information

NPI: 1467945840
Provider Name (Legal Business Name): BRANDY LYNN HANSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 S YATES BLVD STE 201
CHICAGO IL
60617-1102
US

IV. Provider business mailing address

7929 S YATES BLVD STE 201
CHICAGO IL
60617-1102
US

V. Phone/Fax

Practice location:
  • Phone: 773-868-6824
  • Fax: 773-868-6828
Mailing address:
  • Phone: 773-966-4569
  • Fax: 773-868-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017179
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: