Provider Demographics
NPI:1619529138
Name:BELLETYNEE, WENDY M (APN, FNP-C, FPA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:BELLETYNEE
Suffix:
Gender:F
Credentials:APN, FNP-C, FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9208
Mailing Address - Country:US
Mailing Address - Phone:224-225-1140
Mailing Address - Fax:224-225-1131
Practice Address - Street 1:214 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9208
Practice Address - Country:US
Practice Address - Phone:224-225-1140
Practice Address - Fax:224-225-1131
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001403363LF0000X
IL209019386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily