Provider Demographics
NPI:1245840636
Name:EDWARDS, BRANDON COLE (NP-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:COLE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CROSSROAD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3142
Mailing Address - Country:US
Mailing Address - Phone:618-499-2941
Mailing Address - Fax:
Practice Address - Street 1:1600 CROSSROAD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3142
Practice Address - Country:US
Practice Address - Phone:618-499-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021668363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily