Male or Other

Brandon S. Blackwood FNP-C

Nurse Practitioner in Lake Forest, IL(View on Map)

Full Name

Brandon Stuart Blackwood FNP-C

NPI Number

1144867441

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/05/2019

Specialties

(Taxonomies)

Code

363L00000X
364SE0003X

Primary Taxonomy

Yes
No

Licenses

State

Illinois

License Number

209020242

Contact
Information

Purpose

Mailing
Location

Address

415 W ALDINE AVE APT 2C
1000 N WESTMORELAND RD

City

Chicago
Lake Forest

State

IL
IL

Postal Code

60657-3601
60045-1658

Country

US
US

Telephone Number

N/A
(847) 234-5600

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 04/15/2020

Provider Address

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