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General NPI Number Information
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NPI Number | 1568938090
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Entity Type | Organization
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Legal Business Name | AFFINITY FAMILY HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 1108 N EAST ST
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City | OLNEY
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State | IL
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Zip | 62450-2462
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Country | US
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Telephone | 618-429-9470
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Fax | 833-944-2035
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Provider Business Mailing Address
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Address Line | 1108 N EAST ST
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City | OLNEY
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State | IL
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Zip | 62450-2462
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Country | US
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Telephone | 618-429-9470
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Fax | 833-944-2035
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Authorized Official
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Title or Position | OWNER
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Name | JAMEE S BALTZELL
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Credential | APRN
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Telephone | 618-429-9470
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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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