Provider Demographics
NPI:1295219764
Name:BRANTLEY, ANJALA DELORIS (CNA)
Entity Type:Individual
Prefix:
First Name:ANJALA
Middle Name:DELORIS
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-3139
Mailing Address - Country:US
Mailing Address - Phone:847-455-5688
Mailing Address - Fax:847-455-0744
Practice Address - Street 1:9811 S JEFFERY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5220
Practice Address - Country:US
Practice Address - Phone:312-221-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide