Healthcare Provider Details

I. General information

NPI: 1396327037
Provider Name (Legal Business Name): MAUREEN ELIZABETH BROCKS-HUSSAIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S MICHIGAN AVE FL 6
CHICAGO IL
60603-3200
US

IV. Provider business mailing address

1233 N PAULINA ST UNIT 3N
CHICAGO IL
60622-3851
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6800
  • Fax:
Mailing address:
  • Phone: 845-797-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209022494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: