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General NPI Number Information
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NPI Number | 1558613489
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Entity Type | Organization
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Legal Business Name | BELLA FAMILY HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 100 DEERPATH
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City | CHARLESTON
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State | IL
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Zip | 61920-9427
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Country | US
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Telephone | 217-345-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 GALEN DR SUITE 101
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City | CHAMPAIGN
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State | IL
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Zip | 61821-7045
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Country | US
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Telephone | 217-355-8346
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MISS JENNIFER MARIE WENZEL
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Credential |
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Telephone | 217-355-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 248.000561
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License Number State | IL
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