Healthcare Provider Details

I. General information

NPI: 1750964714
Provider Name (Legal Business Name): LIFE HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 DIXIE HWY STE 104
FLOSSMOOR IL
60422-1974
US

IV. Provider business mailing address

1835 DIXIE HWY STE 104
FLOSSMOOR IL
60422-1974
US

V. Phone/Fax

Practice location:
  • Phone: 312-285-2100
  • Fax: 312-285-2854
Mailing address:
  • Phone: 312-285-2100
  • Fax: 312-285-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VONNISE RENEE' HUSSEY
Title or Position: OWNER/DOCTORATE FNP
Credential: DNP, APN, FNP-BC
Phone: 312-285-2100