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NPI Code Detail

MEDICARE: MR. BRANDON MICHAEL OTTERSON RN

MEDICARE: MR. BRANDON MICHAEL OTTERSON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041399907IL

General Provider Information

NPI Number : 1033071691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRANDON MICHAEL OTTERSON RN
Provider Business Mailing Address
First Line : 450 W HIGHWAY 22
Second Line :
City : BARRINGTON
State : IL
Zip : 60010-1919
Country : US
Telephone Number : 847-381-9600
Fax Number : 847-842-4166
Provider Business Practice Location Address
First Line : 450 W HIGHWAY 22
Second Line :
City : BARRINGTON
State : IL
Zip : 60010-1919
Country : US
Telephone Number : 847-381-9600
Fax Number : 847-842-4166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2025
Last Update Date : 12/02/2025

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