Provider Demographics
NPI:1083330518
Name:BANWO WELLNESS CENTER
Entity Type:Organization
Organization Name:BANWO WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGOBANWO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:630-755-1754
Mailing Address - Street 1:718 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3462
Mailing Address - Country:US
Mailing Address - Phone:630-755-1754
Mailing Address - Fax:
Practice Address - Street 1:718 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3462
Practice Address - Country:US
Practice Address - Phone:630-755-1754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care