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General NPI Number Information
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NPI Number | 1134778996
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Entity Type | Organization
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Legal Business Name | JOURNEY AWARENESS LLC
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 2843 CHICAGO RD
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City | SOUTH CHICAGO HEIGHTS
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State | IL
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Zip | 60411-4736
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Country | US
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Telephone | 708-441-2158
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Fax | 708-575-1669
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Provider Business Mailing Address
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Address Line | 2843 CHICAGO RD
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City | SOUTH CHICAGO HEIGHTS
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State | IL
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Zip | 60411-4736
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Country | US
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Telephone | 708-441-2158
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Fax | 708-575-1669
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Authorized Official
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Title or Position | MANAGER
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Name | GINGER DEAN
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Credential | NP
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Telephone | 708-441-2158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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