Healthcare Provider Details

I. General information

NPI: 1619529138
Provider Name (Legal Business Name): WENDY M BELLETYNEE APN, FNP-C, FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 W DUNDEE RD
BUFFALO GROVE IL
60089-3758
US

IV. Provider business mailing address

214 WASHINGTON ST STE 2
INGLESIDE IL
60041-9208
US

V. Phone/Fax

Practice location:
  • Phone: 224-601-5001
  • Fax: 224-333-7063
Mailing address:
  • Phone: 224-225-1140
  • Fax: 224-225-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019386
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: