Provider Demographics
NPI:1699166892
Name:KOUZOUKAS, BRENNA KATHLEEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:KATHLEEN
Last Name:KOUZOUKAS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:BRENNA
Other - Middle Name:KATHLEEN
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1675 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1110
Practice Address - Country:US
Practice Address - Phone:847-723-5313
Practice Address - Fax:847-723-2325
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012491363LF0000X
IL277-004084363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily