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General NPI Number Information
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NPI Number | 1861555120
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Entity Type | Organization
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Legal Business Name | JOELLE A WENNLUND M D LTD
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1938 E LINCOLN HWY STE 207
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City | NEW LENOX
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State | IL
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Zip | 60451-3810
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Country | US
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Telephone | 815-463-9040
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Fax | 815-463-9056
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Provider Business Mailing Address
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Address Line | 1938 E LINCOLN HWY STE 207
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City | NEW LENOX
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State | IL
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Zip | 60451-3810
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Country | US
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Telephone | 815-463-9040
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Fax | 815-463-9056
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Authorized Official
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Title or Position | OWNER
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Name | JOELLE A WENNLUND
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Credential | M.D.
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Telephone | 815-463-9040
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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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