Healthcare Provider Details

I. General information

NPI: 1649196676
Provider Name (Legal Business Name): ALEXIS PENESCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 BUSHWOOD DR
ELGIN IL
60124-7898
US

IV. Provider business mailing address

17N855 HIDDEN HILLS TRL
WEST DUNDEE IL
60118-9519
US

V. Phone/Fax

Practice location:
  • Phone: 224-293-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: