MARY L BRANDENBURG (NPI# 1649385873) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649385873 |
| Entity Type | Individual |
| Full Name | MARY L BRANDENBURG |
| Other Name | MARY L BRECHT |
| Credential | PA |
| Practice Address |
1301 E Walnut St Carbondale IL 62901-5004 |
| Mailing Address |
Po Box 577 Carterville IL 62918-0577 |
| Practice Telephone | 6184573371 |
| Practice Fax Number | 6184578931 |
| Mailing Telephone | 6189858221 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-001021 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE LICENSE NUMBER | 085001021 | 01 |
| IL | MEDICARE RR | CF3444 | 01 |
| IL | HEALTH ALLIANCE | 105008 | 01 |
| IL | 370966854015 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003394024 | Mary Patricia Brandenburg | Nurse Practitioner | 2300 M St Nw Fl 5, Washington, DC 20037 | 2018-08-01 |
| 1760813828 | Mary Brandenburg | Counselor | 18737 68th Ave Ne, Kenmore, WA 98028-2606 | 2013-11-27 |
| 1235258583 | Mary Pratt Brandenburg | Acupuncturist | 5570 Sterrett Pl, Suite 308, Columbia, MD 21044-2641 | 2007-03-28 |
| Street Address |
1301 E WALNUT ST |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-5004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255844296 | Mandy Jo Mckee | Social Worker | 1301 E Walnut St, Carbondale, IL 62901-5004 | 2017-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821618471 | Derrik Abell | Physician Assistant | 11648 Rolling Meadows Ln, Carbondale, IL 62901-0750 | 2020-04-23 |
| 1598277907 | Mallory Lindberg | Physician Assistant | 207 W Jackson St Ste 201, Carbondale, IL 62901-1408 | 2017-10-26 |
| 1790009488 | Northeast Physician Housecalls, Inc. | Physician Assistant | 52 Dundaff St, Carbondale, PA 18407-1879 | 2010-03-24 |
| 1164618633 | Rachel Marie Sargent | Physician Assistant | 600 N. Giant City Rd, Carbondale, IL 62902-6413 | 2007-09-19 |
| 1851502421 | Kelly K Hand | Physician Assistant | 665 E Lake Rd, Carbondale, IL 62901-5347 | 2007-05-25 |
| 1073729877 | Kathleen Ann Dodd | Physician Assistant | 374 East Grand, Carbondale, IL 62901-6740 | 2007-05-16 |
| 1376680462 | Gabriel A Martin | Physician Assistant | 103 S Washington St, Suite 202, Carbondale, IL 62901-3030 | 2007-01-30 |
| 1841237120 | Patricia A Boudet | Physician Assistant | 404 S Lewis Ln, Carbondale, IL 62901-3547 | 2006-06-02 |
| 1871542811 | Michael Anthony Bryant | Physician Assistant | 305 W Jackson St Ste 103, Carbondale, IL 62901-1474 | 2006-05-08 |
| 1821055047 | Kenneth John Bannon | Physician Assistant | 111 Salem Avenue, Suite 302, Carbondale, PA 18407-2574 | 2006-05-01 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on MARY L BRANDENBURG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.