Healthcare Provider Details

I. General information

NPI: 1205682481
Provider Name (Legal Business Name): VITAL FLOW VITALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

IV. Provider business mailing address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

V. Phone/Fax

Practice location:
  • Phone: 312-761-2111
  • Fax:
Mailing address:
  • Phone: 312-761-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA J HENDERSON
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 312-761-2111