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General NPI Number Information
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NPI Number | 1265308936
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Entity Type | Organization
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Legal Business Name | AA WARRIOR HOLISTIC WELLNESS PRACTICE LLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 149 LILAC ST
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City | BOLINGBROOK
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State | IL
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Zip | 60490-2022
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Country | US
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Telephone | 910-676-2227
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1087
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Country | US
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Telephone | 910-676-2227
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ALYSA ANGEL
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Credential | DNP,APRN,
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Telephone | 910-676-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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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 | 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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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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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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