Provider Demographics
NPI:1356956973
Name:RISE AND THRIVE HEALTH CARE PLLC
Entity type:Organization
Organization Name:RISE AND THRIVE HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:KANDIS
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:815-685-4665
Mailing Address - Street 1:1106 N LARKIN AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3455
Mailing Address - Country:US
Mailing Address - Phone:815-685-4665
Mailing Address - Fax:630-566-3322
Practice Address - Street 1:1106 N LARKIN AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3455
Practice Address - Country:US
Practice Address - Phone:815-685-4665
Practice Address - Fax:630-566-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245876846Medicaid