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General NPI Number Information
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NPI Number | 1881063873
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Entity Type | Organization
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Legal Business Name | HEALTHY MEDICAL, LLC
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Dates
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Enumeration Date | 09/19/2015
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Last Update Date | 09/19/2015
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Provider Practice Location Address
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Address Line | 205 HIGHPOINT DR
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City | ESSEX
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State | IL
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Zip | 60935-6160
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Country | US
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Telephone | 708-769-4758
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Fax |
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Provider Business Mailing Address
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Address Line | 205 HIGHPOINT DR
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City | ESSEX
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State | IL
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Zip | 60935-6160
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Country | US
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Telephone | 708-769-4758
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER (OWNER)
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Name | MICHELLE RENEE AXIUM
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Credential | FNP-BC
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Telephone | 708-769-4758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 209.007967
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License Number State | IL
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