HYDE PARK MENTAL WELLNESS


Address: 1525 E 55th St Ste 205, Chicago, IL 60615-5584
Phone: 7738343561

HYDE PARK MENTAL WELLNESS (NPI# 1114574886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1114574886
Entity Type Organization
Organization Name HYDE PARK MENTAL WELLNESS
Practice Address 1525 E 55th St Ste 205
Chicago
IL 60615-5584
Practice Telephone 7738343561
Practice Fax Number 4053077611
Mailing Telephone 7738343561
Mailing Fax Number 4053077611
Enumeration Date 2019-08-19
Last Update Date 2019-10-23
Authorized Official Name ANDREW RICHARDSON (OWNER)
Authorized Official Telephone 7738343561
Authorized Official Credential PMHNP-BC
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 1525 E 55TH ST STE 205
City CHICAGO
State IL
Zip Code 60615-5584

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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1770068421 Gian Bonador Nurse Practitioner 1134 W Granville Ave Apt 715, Chicago, IL 60660-5047 2018-09-28
1790115293 Stacey Marie Meyers Nurse Practitioner 6439 N Sheridan Rd Ste 310, Chicago, IL 60626-5364 2013-11-19
1326385824 Deborah Francine Bump Nurse Practitioner 6918 S Euclid Ave, Chicago, IL 60649-1512 2013-01-03
1104058221 Lester Eugene Lamee Jr. Nurse Practitioner 251 E Huron Street, Northwestern Memorial Hospital, Chicago, IL 60611 2009-08-24
1720003577 Janice E Stern Nurse Practitioner 1645 W Jackson Blvd Ste 602, Chicago, IL 60612 2006-07-13
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Competitor

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City CHICAGO
Zip Code 60615

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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