Provider Demographics
NPI:1578377198
Name:BREWSTER PERRY, MOLLY BANFIELD (DNP, RN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:BANFIELD
Last Name:BREWSTER PERRY
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E ONTARIO ST STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3281
Mailing Address - Country:US
Mailing Address - Phone:312-926-0001
Mailing Address - Fax:
Practice Address - Street 1:211 E ONTARIO ST STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3281
Practice Address - Country:US
Practice Address - Phone:312-926-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041386441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse