Healthcare Provider Details

I. General information

NPI: 1669250502
Provider Name (Legal Business Name): OLLIETREE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 W FALCON CT
MONEE IL
60449-8697
US

IV. Provider business mailing address

4802 W FALCON CT
MONEE IL
60449-8697
US

V. Phone/Fax

Practice location:
  • Phone: 866-687-3348
  • Fax:
Mailing address:
  • Phone: 866-687-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLLIE ROGERS
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 866-687-3348