Brady, Michelle A

Brady, Michelle A is an individual health care provider with primary practice located at 1200 W State St , Rockford IL 61102-2112. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Brady, Michelle A can be contacted via phone (815) 490-1600.

Contact Information

Primary practice address
1200 W State St Rockford IL 61102-2112
Phone: (815) 490-1600
Fax: (815) 490-1625
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209003868 Illinois

Profile Details

NPI number 1396735379
LBN Legal business name Brady, Michelle A
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2005
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396735379 NPPES
Illinois Other 309001823 IL STATE CTL SUB LICENSE
Illinois MEDICAID 209003868 IL STATE CTL SUB LICENSE
Illinois Other 209003868 IL STATE CTL SUB LICENSE

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