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NPI Code Detail

MEDICARE: JOURNEY AWARENESS LLC

MEDICARE: JOURNEY AWARENESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner
2363LG0600XGerontology Nurse Practitioner
3363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1134778996
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOURNEY AWARENESS LLC
Provider Business Mailing Address
First Line : 2843 CHICAGO RD
Second Line :
City : SOUTH CHICAGO HEIGHTS
State : IL
Zip : 60411-4736
Country : US
Telephone Number : 708-441-2158
Fax Number : 708-575-1669
Provider Business Practice Location Address
First Line : 2843 CHICAGO RD
Second Line :
City : SOUTH CHICAGO HEIGHTS
State : IL
Zip : 60411-4736
Country : US
Telephone Number : 708-441-2158
Fax Number : 708-575-1669
Authorized Official
Title or Position : MANAGER
Name : GINGER DEAN
Credential : NP
Telephone Number : 708-441-2158
Provider Enumeration Date : 09/05/2019
Last Update Date : 09/05/2019

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