Healthcare Provider Details

I. General information

NPI: 1124979380
Provider Name (Legal Business Name): FUNCHES HEALTHCARE PLLC DBA VIRTUAL HEALTH 78 & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6142 ROOSEVELT RD STE 202-3
OAK PARK IL
60304-2311
US

IV. Provider business mailing address

1005 S MONITOR AVE
CHICAGO IL
60644-5434
US

V. Phone/Fax

Practice location:
  • Phone: 224-384-5465
  • Fax:
Mailing address:
  • Phone: 224-384-5465
  • Fax:

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: TATANISHA FUNCHES
Title or Position: OWNER
Credential: NP
Phone: 224-384-5465