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General NPI Number Information
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NPI Number | 1275334500
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Entity Type | Organization
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Legal Business Name | RENEW MIGRAINE AND WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 03/22/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1775 GLENVIEW RD STE 103
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City | GLENVIEW
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State | IL
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Zip | 60025-2943
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Country | US
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Telephone | 847-637-8818
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Fax | 847-637-8817
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Provider Business Mailing Address
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Address Line | 1775 GLENVIEW RD STE 103
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City | GLENVIEW
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State | IL
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Zip | 60025-2943
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Country | US
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Telephone | 847-637-8818
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Fax | 847-637-8817
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Authorized Official
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Title or Position | OWNER
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Name | BROOKE PHENICIE
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Credential | APRN-FPA, FNP-BC
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Telephone | 260-243-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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