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Organization
RESTORE HYDRATION & WELLNESS CLINIC INC
Active
Organization
RESTORE HYDRATION & WELLNESS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEINESHA S COX (OWNER)
(779) 374-1207
Entity
Organization
Contact information
Practice address
1838B W 95TH ST, CHICAGO, IL 60643-1104
(779) 374-1207
Mailing address
1838B W 95TH ST, CHICAGO, IL 60643-1104
(779) 374-1207
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Enumeration date
06/10/2026
Last updated
06/10/2026
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