Provider Demographics
NPI:1750964714
Name:LIFE HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:LIFE HEALTH AND WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTORATE FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:VONNISE
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, FNP-BC
Authorized Official - Phone:312-285-2100
Mailing Address - Street 1:1835 DIXIE HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1974
Mailing Address - Country:US
Mailing Address - Phone:312-285-2100
Mailing Address - Fax:312-285-2854
Practice Address - Street 1:1835 DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1974
Practice Address - Country:US
Practice Address - Phone:312-285-2100
Practice Address - Fax:312-285-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty