Provider Demographics
NPI:1609462514
Name:VALENTINE, BRANDON JAMES (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-6843
Mailing Address - Country:US
Mailing Address - Phone:815-342-4455
Mailing Address - Fax:
Practice Address - Street 1:1715 N DIVISION ST STE 4D5E
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3100
Practice Address - Country:US
Practice Address - Phone:815-431-3410
Practice Address - Fax:815-431-3411
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily