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General NPI Number Information
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NPI Number | 1851072359
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Entity Type | Organization
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Legal Business Name | STELLER WELLNESS
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 1410 E VILLAGE PKWY STE B
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City | MT ZION
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State | IL
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Zip | 62549-1253
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Country | US
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Telephone | 217-855-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 E VILLAGE PKWY STE B
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City | MT ZION
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State | IL
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Zip | 62549-1253
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Country | US
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Telephone | 217-855-7447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATELYN KELLER
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Credential | APRN
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Telephone | 217-620-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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