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General NPI Number Information
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NPI Number | 1821787805
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Entity Type | Organization
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Legal Business Name | WELLNESS CARE CLINIC
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 701 SAINT NICHOLAS DR
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City | CAHOKIA
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State | IL
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Zip | 62206-1837
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Country | US
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Telephone | 888-995-2802
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Fax | 618-306-9518
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Provider Business Mailing Address
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Address Line | 355 WINCHESTER PL
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208
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Country | US
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Telephone | 618-792-5970
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Fax | 618-306-9518
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Authorized Official
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Title or Position | OWNER
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Name | GINGER DARTY
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Credential | FNP
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Telephone | 618-792-5970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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