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General NPI Number Information
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NPI Number | 1366129157
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Entity Type | Organization
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Legal Business Name | AFFINITY HEALTHCARE AND WELLNESS PLLC
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 305 N VINE ST STE 205
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City | NEW LENOX
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State | IL
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Zip | 60451-1643
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Country | US
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Telephone | 762-448-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N VINE ST STE 205
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City | NEW LENOX
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State | IL
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Zip | 60451-1643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY REYNOLDS
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Credential | FNP
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Telephone | 815-846-3737
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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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