Provider Demographics
NPI:1184248775
Name:HUTCHINSON, BRANDON DEWILE SR
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DEWILE
Last Name:HUTCHINSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4966
Mailing Address - Country:US
Mailing Address - Phone:815-345-7250
Mailing Address - Fax:
Practice Address - Street 1:261 VIOLET DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4966
Practice Address - Country:US
Practice Address - Phone:815-345-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILH32506467010343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)