Provider Demographics
NPI:1750830451
Name:EICHELBERGER, BRANDY (ANP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:EICHELBERGER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 NOTTINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6883
Mailing Address - Country:US
Mailing Address - Phone:618-530-1509
Mailing Address - Fax:
Practice Address - Street 1:208 W POINTE DR STE D
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8302
Practice Address - Country:US
Practice Address - Phone:618-641-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014835363LF0000X, 363LP0808X
IL277001227363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily