Provider Demographics
NPI:1053022152
Name:ESSENTIAL HEALTHNP LLC
Entity type:Organization
Organization Name:ESSENTIAL HEALTHNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:312-590-1975
Mailing Address - Street 1:8833 S CRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3051
Mailing Address - Country:US
Mailing Address - Phone:312-590-1975
Mailing Address - Fax:
Practice Address - Street 1:2315 E 93RD ST STE 339
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3916
Practice Address - Country:US
Practice Address - Phone:312-590-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty