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General NPI Number Information
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NPI Number | 1528704657
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE PCP, PLLC
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 275 12TH ST STE 2D
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City | WHEELING
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State | IL
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Zip | 60090-2015
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Country | US
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Telephone | 847-777-8887
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Fax |
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Provider Business Mailing Address
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Address Line | 275 12TH ST STE 2D
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City | WHEELING
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State | IL
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Zip | 60090-2015
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Country | US
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Telephone | 847-777-8887
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANNA VINTONYAK
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Credential | APRN
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Telephone | 847-777-8887
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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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