Healthcare Provider Details

I. General information

NPI: 1235676362
Provider Name (Legal Business Name): PREVENTATIVE HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 N NORTHWEST HWY 304
CHICAGO IL
60631-1307
US

IV. Provider business mailing address

6650 N NORTHWEST HWY 304
CHICAGO IL
60631-1307
US

V. Phone/Fax

Practice location:
  • Phone: 773-732-0762
  • Fax:
Mailing address:
  • Phone: 773-732-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041334818
License Number StateIL

VIII. Authorized Official

Name: MICHELLE HYNES
Title or Position: CEO
Credential: RN
Phone: 773-419-1884