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General NPI Number Information
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NPI Number | 1922476241
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Entity Type | Organization
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Legal Business Name | WHOLE HEALTH FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 922 TALON DR SUITE B
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City | O FALLON
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone | 618-622-1200
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Fax | 314-270-5283
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Provider Business Mailing Address
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Address Line | 825 SAYBROOK FALLS DR
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2168
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Country | US
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Telephone | 618-622-1200
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Fax | 314-270-5283
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. CRYSTAL S JESENICK
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Credential | APN, FNP-C
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Telephone | 618-622-1200
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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 | 209006003
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License Number State | IL
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