=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619529138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY M BELLETYNEE APN, FNP-C, FPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2019
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 WASHINGTON ST STE 2
-----------------------------------------------------
City | INGLESIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60041-9208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-225-1140
-----------------------------------------------------
Fax | 224-225-1131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 WASHINGTON ST STE 2
-----------------------------------------------------
City | INGLESIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60041-9208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-225-1140
-----------------------------------------------------
Fax | 224-225-1131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 277001403
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209019386
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------