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General NPI Number Information
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NPI Number | 1144731944
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Entity Type | Organization
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Legal Business Name | HOPE WELLNESS CENTER AND SPA PC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE STE 103
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City | CHICAGO
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State | IL
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Zip | 60643-2541
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Country | US
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Telephone | 773-985-5734
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Fax | 773-941-5131
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Provider Business Mailing Address
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Address Line | 10540 S WESTERN AVE STE 103
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City | CHICAGO
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State | IL
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Zip | 60643-2541
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Country | US
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Telephone | 773-985-5734
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Fax | 773-941-5131
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. MARIA JEFFERSON-WALKER
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Credential | APRN
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Telephone | 773-985-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209010507
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License Number State | IL
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