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General NPI Number Information
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NPI Number | 1073318358
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Entity Type | Individual
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Provider Name | BRANDON BARRIOS
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Gender | Male
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 3010 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-377-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 CARMEL BLVD
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City | ZION
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State | IL
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Zip | 60099-3630
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Country | US
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Telephone | 224-717-6587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16510-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.032032
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License Number State | IL
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