Provider Demographics
NPI:1821787805
Name:WELLNESS CARE CLINIC
Entity type:Organization
Organization Name:WELLNESS CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARTY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:618-792-5970
Mailing Address - Street 1:355 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208
Mailing Address - Country:US
Mailing Address - Phone:618-792-5970
Mailing Address - Fax:618-306-9518
Practice Address - Street 1:701 SAINT NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-1837
Practice Address - Country:US
Practice Address - Phone:888-995-2802
Practice Address - Fax:618-306-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty