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General NPI Number Information
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NPI Number | 1003574757
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Entity Type | Organization
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Legal Business Name | EBONY WELLNESS LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 7531 S STONY ISLAND AVE STE 164
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City | CHICAGO
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State | IL
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Zip | 60649-3954
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Country | US
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Telephone | 773-947-7689
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Fax | 773-947-7338
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Provider Business Mailing Address
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Address Line | 7220 W 83RD ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1981
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Country | US
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Telephone | 773-947-7689
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY DOBBIN
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Credential | NP
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Telephone | 773-960-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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