Healthcare Provider Details

I. General information

NPI: 1326972514
Provider Name (Legal Business Name): LUMINA WELLNESS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 GOVERNORS DR. 3RD FLOOR SUITE 333
OLYMPIAN FIELD IL
60461
US

IV. Provider business mailing address

5331 SOUTH INDIANA AVE UNIT 3
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 773-413-8533
  • Fax: 773-413-9577
Mailing address:
  • Phone: 773-413-8533
  • Fax: 773-413-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BASIRAT SULAIMAN
Title or Position: OWNER
Credential:
Phone: 773-413-8533