Healthcare Provider Details

I. General information

NPI: 1487167698
Provider Name (Legal Business Name): BRENNA MOLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27790 WEST HIGHWAY 22 MOC1
BARRINGTON IL
60010
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-620-6077
  • Fax: 847-842-4887
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016489
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: