Healthcare Provider Details

I. General information

NPI: 1851072359
Provider Name (Legal Business Name): STELLER WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E VILLAGE PKWY STE B
MT ZION IL
62549-1253
US

IV. Provider business mailing address

1410 E VILLAGE PKWY STE B
MT ZION IL
62549-1253
US

V. Phone/Fax

Practice location:
  • Phone: 217-855-7447
  • Fax:
Mailing address:
  • Phone: 217-855-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATELYN KELLER
Title or Position: OWNER
Credential: APRN
Phone: 217-620-3977