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General NPI Number Information
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NPI Number | 1497525679
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Entity Type | Organization
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Legal Business Name | MAYSAH EHEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 310 N HAMMES AVE STE 300B
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City | JOLIET
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State | IL
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Zip | 60435-7661
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Country | US
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Telephone | 815-714-9933
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Fax | 949-695-3321
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Provider Business Mailing Address
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Address Line | 21349 WESTMINSTER LN
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City | SHOREWOOD
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State | IL
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Zip | 60404-2501
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Country | US
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Telephone | 815-714-9933
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MUTENGWANA KASAPU-MWABA
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Credential | FNP
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Telephone | 678-559-5065
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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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