Healthcare Provider Details

I. General information

NPI: 1477211597
Provider Name (Legal Business Name): ROSSYVETTE HARRINGTON NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD # 11PC
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

4829 KINGS WAY W
GURNEE IL
60031-3257
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-1278
  • Fax:
Mailing address:
  • Phone: 847-749-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3386792
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: