Provider Demographics
NPI:1811777683
Name:TREJO, ELIDA GRICELDA (FNP)
Entity type:Individual
Prefix:
First Name:ELIDA
Middle Name:GRICELDA
Last Name:TREJO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1425 NORTH HUNT CLUB ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-548-2200
Mailing Address - Fax:847-548-2865
Practice Address - Street 1:1425 NORTH HUNT CLUB ROAD
Practice Address - Street 2:STE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-548-2200
Practice Address - Fax:847-548-2865
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041494182163WA0400X
IL209028323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)