Provider Demographics
NPI:1427730274
Name:BURNETT, BRANDON JAMES (APRN CNP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:BURNETT
Suffix:
Gender:M
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SYDNEY PL
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6630
Mailing Address - Country:US
Mailing Address - Phone:217-254-7516
Mailing Address - Fax:
Practice Address - Street 1:525 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3318
Practice Address - Country:US
Practice Address - Phone:309-836-1744
Practice Address - Fax:309-836-1745
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily