Healthcare Provider Details

I. General information

NPI: 1730343815
Provider Name (Legal Business Name): JOAN MARIE BRNCICH RN.FA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 COPPERFIELD AVE SUITE 4040
JOLIET IL
60432-2004
US

IV. Provider business mailing address

1300 COPPERFIELD AVE SUITE 4040
JOLIET IL
60432-2004
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-3030
  • Fax: 815-740-4964
Mailing address:
  • Phone: 815-727-3030
  • Fax: 815-740-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number041236998
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: