Provider Demographics
NPI:1275334500
Name:RENEW MIGRAINE AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:RENEW MIGRAINE AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHENICIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA, FNP-BC
Authorized Official - Phone:260-243-1440
Mailing Address - Street 1:3147 VALCOUR DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-6902
Mailing Address - Country:US
Mailing Address - Phone:260-243-1440
Mailing Address - Fax:
Practice Address - Street 1:1775 GLENVIEW RD STE 103
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2943
Practice Address - Country:US
Practice Address - Phone:847-637-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty