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General NPI Number Information
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NPI Number | 1912791575
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Entity Type | Organization
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Legal Business Name | WILEY FAMILY HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 20650 S CICERO AVE UNIT 493
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City | MATTESON
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State | IL
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Zip | 60443-3419
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Country | US
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Telephone | 708-664-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 21224 GRAY HAWK DR
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City | MATTESON
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State | IL
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Zip | 60443-3314
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Country | US
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Telephone | 708-664-8888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARETTA WILEY
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Credential | FNP-BC, PMHNP-BC
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Telephone | 708-664-8888
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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