Healthcare Provider Details

I. General information

NPI: 1427964030
Provider Name (Legal Business Name): ISHA WARDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 SAUK TRL
RICHTON PARK IL
60471-1339
US

IV. Provider business mailing address

426 BURLWOOD CT
MATTESON IL
60443-2140
US

V. Phone/Fax

Practice location:
  • Phone: 708-365-8489
  • Fax:
Mailing address:
  • Phone: 708-724-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number011.274917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: