Provider Demographics
NPI:1417630229
Name:BLUEHEALTH MEDICAL LLC
Entity Type:Organization
Organization Name:BLUEHEALTH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY-JENNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:773-951-0941
Mailing Address - Street 1:3210 N KILBOURN AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4571
Mailing Address - Country:US
Mailing Address - Phone:773-951-0941
Mailing Address - Fax:
Practice Address - Street 1:3210 N KILBOURN AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4571
Practice Address - Country:US
Practice Address - Phone:773-951-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty