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General NPI Number Information
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NPI Number | 1609673219
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Entity Type | Organization
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Legal Business Name | FIT TO FIGHT
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 3920 E IL ROUTE 64
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City | OREGON
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State | IL
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Zip | 61061-9634
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Country | US
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Telephone | 815-562-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 E IL ROUTE 64
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City | OREGON
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State | IL
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Zip | 61061-9634
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Country | US
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Telephone | 815-562-3362
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARLA JO VANVICKLE
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Credential | FNP-C
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Telephone | 815-562-3362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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