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General NPI Number Information
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NPI Number | 1083250450
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Entity Type | Individual
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Provider Name | BRANDY MCCRUDDEN DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 6811 167TH ST UNIT 2
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City | TINLEY PARK
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State | IL
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Zip | 60477-2501
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Country | US
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Telephone | 708-232-8854
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Fax | 708-854-0714
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Provider Business Mailing Address
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Address Line | 6811 167TH ST UNIT 2
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City | TINLEY PARK
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State | IL
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Zip | 60477-2501
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Country | US
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Telephone | 708-232-8854
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Fax | 708-854-0714
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277004256
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License Number State | IL
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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 | 277004256
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277004256
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License Number State | IL
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