Provider Demographics
NPI:1881348092
Name:O'BRIEN, ELLE
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 1010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3845
Mailing Address - Country:US
Mailing Address - Phone:312-226-2371
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 1010
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3845
Practice Address - Country:US
Practice Address - Phone:312-226-2371
Practice Address - Fax:312-563-0715
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-008813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant