MEDICARE: ELIANA J MENNINGEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	041494686	IL

General Provider Information

NPI Number	:	1699630830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIANA J MENNINGEN

Provider Business Mailing Address
First Line	:	2203 W ADDISON ST BSMT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4941
Country	:	US
Telephone Number	:	312-702-0435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 W ADDISON ST BSMT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4941
Country	:	US
Telephone Number	:	312-702-0435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ ELIANA J MENNINGEN ” Practice Location

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