Provider Demographics
NPI:1174803878
Name:CLEAR RIDGE WELLNESS CENTER LTD.
Entity type:Organization
Organization Name:CLEAR RIDGE WELLNESS CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:STELLE-BETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP-BC
Authorized Official - Phone:309-287-5506
Mailing Address - Street 1:6745 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4003
Mailing Address - Country:US
Mailing Address - Phone:773-229-8545
Mailing Address - Fax:773-229-8545
Practice Address - Street 1:6745 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4003
Practice Address - Country:US
Practice Address - Phone:773-229-8545
Practice Address - Fax:773-229-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.283154261QP2300X
IL209.008667261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care