Healthcare Provider Details

I. General information

NPI: 1073450029
Provider Name (Legal Business Name): BRANDI L ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 OLD PORTER RD
PORTER IN
46304-9404
US

IV. Provider business mailing address

442 N CALUMET RD STE 100
CHESTERTON IN
46304-2490
US

V. Phone/Fax

Practice location:
  • Phone: 219-281-2431
  • Fax: 219-232-6105
Mailing address:
  • Phone: 219-281-2431
  • Fax: 219-232-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number71018016A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018016A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: