MEDICARE: ELIDA GRICELDA TREJO FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	277004895	IL
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	041494182	IL

General Provider Information

NPI Number	:	1811777683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIDA GRICELDA TREJO FNP-BC

Provider Business Mailing Address
First Line	:	1425 N HUNT CLUB RD STE 100
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-2632
Country	:	US
Telephone Number	:	847-548-2200
Fax Number	:	847-548-2865

Provider Business Practice Location Address
First Line	:	11316 W WADSWORTH RD STE 103
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60099-3367
Country	:	US
Telephone Number	:	708-404-9070
Fax Number	:	708-273-5565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	04/06/2026

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