Provider Demographics
NPI:1083170278
Name:HATCHER, BRANDY J (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:J
Last Name:HATCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 N DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2219
Mailing Address - Country:US
Mailing Address - Phone:517-402-5645
Mailing Address - Fax:
Practice Address - Street 1:610 S MAPLE AVE STE 5900
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2814
Practice Address - Country:US
Practice Address - Phone:708-660-5400
Practice Address - Fax:708-660-5401
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily