Healthcare Provider Details

I. General information

NPI: 1235371238
Provider Name (Legal Business Name): JULIE E BRACKEN RN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 W 99TH ST
EVERGREEN PARK IL
60805-3641
US

IV. Provider business mailing address

2616 W 99TH ST
EVERGREEN PARK IL
60805-3641
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-3156
  • Fax:
Mailing address:
  • Phone: 708-636-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209000130
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041176100
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: