Healthcare Provider Details
I. General information
NPI: 1871340349
Provider Name (Legal Business Name): ENVISION HEALTH & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/02/2024
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1316 E ALGONQUIN RD STE 106
ALGONQUIN IL
60102-4227
US
IV. Provider business mailing address
1316 E ALGONQUIN RD STE 106
ALGONQUIN IL
60102-4227
US
V. Phone/Fax
- Phone: 224-578-8991
- Fax:
- Phone: 224-578-8991
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MICHELLE
J
BATOR
Title or Position: CEO/OWNER
Credential: PMHNP-BC, FNP-BC
Phone: 224-578-8991