Provider Demographics
NPI:1801571229
Name:HEARTLAND WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:HEARTLAND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:TALETHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:708-491-2655
Mailing Address - Street 1:304 QUEENS LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1080
Mailing Address - Country:US
Mailing Address - Phone:708-564-5071
Mailing Address - Fax:708-564-5010
Practice Address - Street 1:304 QUEENS LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1080
Practice Address - Country:US
Practice Address - Phone:708-564-5071
Practice Address - Fax:708-564-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty