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MARY L BRANDENBURG PA
NPI 1649385873
Physician Assistant in Carbondale, IL

Active since August 20, 2006
1301 E WALNUT ST, CARBONDALE, IL 62901(618) 457-3371(618) 457-8931 Get Directions Write a Review

NPPES record last updated: September 13, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary L Brandenburg Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY L BRANDENBURG PA (NPI 1649385873) is an individual physician assistant in Carbondale, Illinois, licensed in Illinois (085-001021) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1649385873
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMARY L BRANDENBURGCredential: PA
Location Address1301 E WALNUT STCarbondale, IL 62901-5004
Mailing AddressPo Box 577Carterville, IL 62918-0577 · (618) 985-8221
Phone(618) 457-3371
Fax(618) 457-8931
Sole ProprietorNo
Enumeration DateAugust 20, 2006
Last NPPES UpdateSeptember 13, 2012
✔ NPI 1649385873 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in IL · 085-001021
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1301 E WALNUT ST, Carbondale, IL 62901
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Other Names 1

Former Name (1)Mary L Brecht Pa

Other Identifiers 6

Other085001021IL · State License Number
OtherCF3444IL · Medicare Rr
Medicare OSCAR/certification141016IL
Medicaid370966854015IL
Other105008IL · Health Alliance
Medicare OSCAR/certification640701IL

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MANDY JO MCKEE LCSW
Social Worker (Clinical)
1301 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 457-3371

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Brandenburg's NPI number?

The NPI number for Mary Brandenburg is 1649385873. It was assigned to this individual provider in the NPPES registry on August 20, 2006. The provider is also known as Mary L Brecht PA.

Where is Mary Brandenburg located?

Mary Brandenburg practices at 1301 E Walnut St, Carbondale, IL 62901. The listed phone number is (618) 457-3371.

What is Mary Brandenburg's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Mary Brandenburg was last updated on September 13, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.