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General NPI Number Information
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NPI Number | 1720968415
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Entity Type | Organization
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Legal Business Name | MOKITA WELLNESS
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 6533 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60637-4209
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Country | US
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Telephone | 708-769-4062
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Fax |
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Provider Business Mailing Address
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Address Line | 6533 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60637-4209
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Country | US
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Telephone | 708-769-4062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIKITA MAHAN
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Credential | RN
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Telephone | 708-769-4062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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