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General NPI Number Information
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NPI Number | 1205624186
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Entity Type | Organization
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Legal Business Name | ELEVATED HEALTH & WELLNESS
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2315 E 93RD ST STE 339
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City | CHICAGO
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State | IL
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Zip | 60617-3916
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Country | US
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Telephone | 312-927-1897
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Fax | 949-703-8941
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Provider Business Mailing Address
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Address Line | 9624 S LOWE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1011
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Country | US
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Telephone | 773-491-4141
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Fax |
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Authorized Official
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Title or Position | APRN, FNP-C
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Name | MS. KEYONA GAYLES
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Credential | MSN, FNP
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Telephone | 773-491-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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