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General NPI Number Information
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NPI Number | 1376196006
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Entity Type | Individual
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Provider Name | BRENNA SELENA LEIKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 24600 W 127TH ST
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City | PLAINFIELD
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State | IL
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Zip | 60585-9507
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Country | US
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Telephone | 630-961-7485
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Fax | 815-731-4406
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 847-570-2114
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Fax | 847-570-1223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085007116
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085007116
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License Number State | IL
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