Healthcare Provider Details

I. General information

NPI: 1295525152
Provider Name (Legal Business Name): BRANDY ELLI MENENDEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDY ELLI RODRIGUEZ FNP-C

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 DALY RD
WHEATON IL
60187-3316
US

IV. Provider business mailing address

1509 DALY RD
WHEATON IL
60187-3316
US

V. Phone/Fax

Practice location:
  • Phone: 630-877-8591
  • Fax:
Mailing address:
  • Phone: 630-877-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.032336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: