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General NPI Number Information
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NPI Number | 1902621980
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Entity Type | Organization
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Legal Business Name | LAKES HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 214 WASHINGTON ST STE 1
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City | INGLESIDE
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State | IL
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Zip | 60041-9208
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Country | US
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Telephone | 815-363-2020
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Fax | 224-225-1003
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Provider Business Mailing Address
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Address Line | 112 GOLF VIEW DR
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City | SPRING GROVE
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State | IL
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Zip | 60081-9024
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Country | US
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Telephone | 815-363-2020
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Fax | 224-225-1003
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY RAE GALLINA
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Credential | APRN, CNM FNP
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Telephone | 815-363-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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