Healthcare Provider Details

I. General information

NPI: 1194662965
Provider Name (Legal Business Name): WHOLISTIC ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 S RACINE AVE
CHICAGO IL
60636-3509
US

IV. Provider business mailing address

1442 W 74TH ST
CHICAGO IL
60636
US

V. Phone/Fax

Practice location:
  • Phone: 872-302-5290
  • Fax: 872-302-5291
Mailing address:
  • Phone: 872-302-5290
  • Fax: 872-302-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELIA MARTIN
Title or Position: PRESIDENT
Credential: APRN
Phone: 773-699-8573