Healthcare Provider Details

I. General information

NPI: 1063002814
Provider Name (Legal Business Name): MPERFECT WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11638 S PULASKI RD STE B
ALSIP IL
60803-1622
US

IV. Provider business mailing address

11638 S PULASKI RD STE B
ALSIP IL
60803-1622
US

V. Phone/Fax

Practice location:
  • Phone: 708-629-6608
  • Fax: 534-429-4415
Mailing address:
  • Phone: 773-484-6042
  • Fax: 534-429-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IESHA COLEMAN-NWAGWU
Title or Position: CEO
Credential: FNP-BC, PMHNP-BC
Phone: 708-629-6608