Provider Demographics
NPI:1750064838
Name:DOERFLEIN, BRANDI ANN (APRN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ANN
Last Name:DOERFLEIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9727
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9727
Mailing Address - Country:US
Mailing Address - Phone:309-886-9172
Mailing Address - Fax:
Practice Address - Street 1:2250 REED STATION PKWY STE 305
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-8104
Practice Address - Country:US
Practice Address - Phone:618-457-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily