Healthcare Provider Details

I. General information

NPI: 1396735379
Provider Name (Legal Business Name): MICHELLE A BRADY F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE A YOE F.N.P.

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W STATE ST
ROCKFORD IL
61102-2112
US

IV. Provider business mailing address

1200 W STATE ST
ROCKFORD IL
61102-2112
US

V. Phone/Fax

Practice location:
  • Phone: 815-490-1600
  • Fax: 815-490-1625
Mailing address:
  • Phone: 815-490-1600
  • Fax: 815-490-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209003868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: