Healthcare Provider Details

I. General information

NPI: 1427730779
Provider Name (Legal Business Name): RIVETING WELLNESS COSMETIC SOLUTIONS AND TRAINING INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 S EAST END AVE APT 1602N
CHICAGO IL
60615-0112
US

IV. Provider business mailing address

5035 S EAST END AVE APT 1602N
CHICAGO IL
60615-0112
US

V. Phone/Fax

Practice location:
  • Phone: 773-983-1362
  • Fax:
Mailing address:
  • Phone: 773-983-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA LEVATER WILSON
Title or Position: CERTIFIED HAIR LOSS SPECIALIST
Credential:
Phone: 774-983-1362