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General NPI Number Information
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NPI Number | 1588458590
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Entity Type | Individual
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Provider Name | ELLIANA BRODY
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Gender |
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 3100 DUNDEE RD STE 101
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City | NORTHBROOK
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State | IL
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Zip | 60062-2462
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Country | US
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Telephone | 847-432-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 DUNDEE RD STE 101
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City | NORTHBROOK
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State | IL
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Zip | 60062-2462
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Country | US
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Telephone |
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Fax | 224-216-2360
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.529434
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.033097
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License Number State | IL
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