{
"Npi": {
"NPI": "1811777683",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TREJO",
"FirstName": "ELIDA",
"MiddleName": "GRICELDA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1425 N HUNT CLUB RD STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GURNEE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60031-2632",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-548-2200",
"MailingAddressFaxNumber": "847-548-2865",
"FirstLinePracticeLocationAddress": "11316 W WADSWORTH RD STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEACH PARK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60099-3367",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-404-9070",
"PracticeLocationAddressFaxNumber": "708-273-5565",
"EnumerationDate": "09/29/2023",
"LastUpdateDate": "04/06/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "277004895",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163WA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Registered Nurse",
"LicenseNumber": "041494182",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}