Ebony Wellness LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

EBONY WELLNESS LLC

Practice address

7531 S Stony Island Ave Ste 164
Chicago, IL 60649-3954

Phone

(773) 947-7689

Fax

(773) 947-7338

NPI assigned

Nov 30, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tammy Dobbin, NP

Title

Owner

Phone

(773) 960-3276

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1003574757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7220 W 83RD ST",
            "city": "BRIDGEVIEW",
            "state": "IL",
            "postal_code": "604551981",
            "telephone_number": "773-947-7689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 S STONY ISLAND AVE STE 164",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493954",
            "telephone_number": "773-947-7689",
            "fax_number": "773-947-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-30",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "DOBBIN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-960-3276",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.